ObjectiveTo investigate the surgical skills and clinical effects of the laparoscopic transabdominal preperitoneal (TAPP) inguinal hernia repair in treatment of recurrent inguinal hernia with plug prefix mesh. MethodsThe clinical data such as operation time, intraoperative blood loss, postoperative hospital stay, and postoperative complications of 87 patients with recurrent inguinal hernia reoperated in laparoscopic TAPP after inguinal hernioplasty with plug prefix mesh (recurrent hernia group), in the Department of Gastroenterology and Hernia surgery of the First Affiliated Hospital of Kunming Medical University from January 2011 to December 2013, were retrospectively analyzed, which were compared with the 834 incipient inguinal hernia patients operated first by TAPP (incipient hernia group) at the same time. ResultsThe operations were completed successfully in all of the 921 patients without conversion to open surgery. The operation time and intraoperative blood loss in the recurrent hernia group were significantly more than those in the incipient hernia group (P=0.000, P=0.000), the postoperative hospital stay had no signifcant difference between two groups (P=0.057). No recurrences were observed in the recurrent hernia group and incipient hernia group for following-up of (31±4) months and (28±6) months, respectively. Compared with the incipient hernia group, the rates of postoperative pain on day 30 and seroma on day 1 and 3 were higher in the recurrent hernia group (P=0.001, P=0.040, P=0.003, respectively). There were no severe complications such as collateral damage, foreign body sensation, incision infection, intestinal obstruction and so on in the two groups. ConclusionsThe laparoscopic TAPP inguinal hernia repair is safe and effective for patients with recurrent inguinal hernia with plug prefix mesh. More skills are required to reduce the complications. The operation time and intraoperative blood loss in reoperated patients with recurrent inguinal hernia are more than those in patients with incipient inguinal hernia. The rates of seroma on day 1 and 3 are also higher.
Test of tissue tolerance to domastic prosthetic materials (carbon fiber mesh, siliconized velvet, silk cloth and dacron cloth) as a subcutaneos transplant was performed in the adcominal wall of rabbit. These implants and their surroundding tissues were excied for studies at second , fourth, eighth and the twelfth weeks after operation. Ratio of fibroblast count to inflammatory cells count which is a common parameter of tissue tolerance was calculated in these four groups. The result shows that fibroblastic cell reaction elicited by carbon fiber mesh is the greates among the four prosthetic materials, the second one is dasron cloth. The inflammatory cell reaction elicited by silk is the greatest among the four materials, the second is carbon fiber mesh, and the dacron cloth the least. Tissure tolerance of dacron cloth is the best in the four prosthetic materials for implantation while sick is the worst.
Morgagni hernia is a rare form (accounting for 2%) of congenital diaphragmatic hernia. The traditional treatment for Morgagni hernia includes thoracotomy and laparotomy. However, surgical trauma limits its adoption. We reported the results of 2 patients with congenital Morgagni hernias in adults and described the operation methods of the patients. The 2 patients recovered uneventfully. No evidence of recurrence was found after 5 years follow-up. Laparoscopic repair for Morgagni hernia with mesh is applicable for obese, aged and bilateral Morgagni hernias patients.
Objective To explore the effectiveness of two-stage operation on free latissimus dorsi myocutaneous flap transplantation and skull contour reconstruction in the treatment of head titanium mesh exposure complicated with soft tissue infection. Methods Between January 2015 and December 2021, 13 patients with head titanium mesh exposure complicated with soft tissue infection were admitted. There were 9 males and 4 females with a mean age of 42.9 years (range, 23-64 years). The duration of titanium mesh exposure was 22-609 days (median, 102 days). The wound site located at the frontal part in 3 cases, the parietal part in 1 case, the occipital part in 2 cases, the frontal-parietal part in 1 case, the temporal-parietal part in 4 cases, and the frontotemporal part in 2 cases. The titanium mesh had been taken out in 5 patients before admission, leaving skull defect and shape collapse, with signs of infection. The bacterial culture was positive in 7 cases and negative in 6 cases. The imaging examination revealed that the size of the skull defect ranged from 6 cm×5 cm to 21 cm×17 cm and the scalp defect ranged from 1 cm×1 cm to 15 cm×10 cm. The soft tissue infection did not reach dura in 5 cases, reached dura in 6 cases, and reached frontal sinus in 2 cases. The two-stage surgical protocol was used in all patients. In the first-stage operation, the latissimus dorsi myocutaneous flap was designed to repair the skull and scalp defects after removing the titanium mesh and thorough debridement. The size of muscle flap ranged from 13.5 cm×4.0 cm to 21.0 cm×17.0 cm, and the skin flap ranged from 7.0 cm×4.0 cm to 15.0 cm×10.0 cm. After the flap survived and stabilized, the second-stage operation was performed. The titanium mesh was implanted to reconstruct the skull contour. The size of titanium mesh ranged from 7.0 cm×6.0 cm to 21.5 cm×17.5 cm. The interval between the first- and second-stage operations was 3.7-17.8 months, with an average of 11.4 months. The survival of the skin flap, the appearance of the head, and the presence of re-exposed titanium mesh and infection were observed after operation. Results At the first-stage operation, venous embolism occurred in 1 case, and no obvious abnormality was observed after treatment. All the flaps survived and the incisions healed by first intention. Besides, the incisions of the second-stage operation healed by first intention. All patients were followed up 1-96 months (median, 14 months). During follow-up, no exposure to titanium mesh, infection, or other complications occurred. The appearance satisfaction rate of the patients was 92.31% (11/13). There was no significant difference in the skull contour between the affected side and the healthy side in all patients. Conclusion For the head titanium mesh exposure with soft tissue infection, the application of two-stage operation on free latissimus dorsi myocutaneous flap transplantation and skull contour reconstruction can reduce the risks of implant exposure and infection again by increasing the thickness of the scalp and blood supply, filling the wound cavity, and obtain good effectiveness.
Objective To study the superiority and efficiency of total peritoneum intraperitoneal onlay mesh (TPIPOM) in laparoscopic inguinal hernioplasty. Methods One hundred and five cases of laparoscopic inguinal hernioplasty with TPIPOM and 34 cases of inguinal hernioplasty with trans-abdominal preperitoneal laparoscopic mesh repair (TAPP) were performed from January 2002 to August 2005. Perioperative data and follow-up results were collected and compared in two groups. Results The laparoscopic hernioplasty was successfully performed in all patients. The total operation time, hospital stay, average off-bed time, duration of pain in TPIPOM group were significant shorter than those in TAPP group 〔(30.8±10.3) min vs (68.4±22.4) min, (3.8±1.3) d vs (4.3±1.5) d, (1.2±0.5) d vs (1.8±0.7) d, (1.0±0.5) d vs (1.6±0.9) d, respectively〕, P＜0.01, the total hospital cost was RMB 5 000.8±800.5 in TPIPOM group and that was RMB 8 000.5±950.6 in TAPP group (P＜0.01). No significant scrotal edema was observed postoperatively and no recurrence reported during (18.6±8.9) months follow-up in both groups. Conclusion Laparoscopic inguinal hernioplasty with TPIPOM is safe and efficacy with advantages of mini-invasion, simple procedures, shorter operation time, no complications and better recovery.
Objective To explore the effect of NaOH on the surface morphology of three-dimensional (3D) printed poly-L-lactic acid (PLLA) mesh scaffolds. Methods The 3D printed PLLA mesh scaffolds were prepared by fused deposition molding technology, then the scaffold surfaces were etched with the NaOH solution. The concentrations of NaOH solution were 0.01, 0.1, 0.5, 1.0, and 3.0 mol/L, and the treatment time was 1, 3, 6, 9, and 12 hours, respectively. There were a total of 25 concentration and time combinations. After treatment, the microstructure, energy spectrum, roughness, hydrophilicity, compressive strength, as well as cell adhesion and proliferation of the scaffolds were observed. The untreated scaffolds were used as a normal control. Results 3D printed PLLA mesh scaffolds were successfully prepared by using fused deposition molding technology. After NaOH etching treatment, a rough or micro porous structure was constructed on the surface of the scaffold, and with the increase of NaOH concentration and treatment time, the size and density of the pores increased. The characterization of the scaffolds by energy dispersive spectroscopy showed that the crystal contains two elements, Na and O. The surface roughness of NaOH treated scaffolds significantly increased (P<0.05) and the contact angle significantly decreased (P<0.05) compared to untreated scaffolds. There was no significant difference in compressive strength between the untreated scaffolds and treated scaffolds under conditions of 0.1 mol/L/12 h and 1.0 mol/L/3 h (P>0.05), while the compression strength of the other treated scaffolds were significantly lower than that of the untreated scaffolds (P<0.05). After co-culturing the cells with the scaffold, NaOH treatment resulted in an increase in the number of cells on the surface of the scaffold and the spreading area of individual cells, and more synapses extending from adherent cells. Conclusion NaOH treatment is beneficial for increasing the surface hydrophilicity and cell adhesion of 3D printed PLLA mesh scaffolds.
ObjectiveTo compare the outcomes after mini-mesh approach to modified Kugel technique in femoral hernia repair.MethodsThe clinical data of 99 patients with primary unilateral femoral hernia who were admitted to The First Affiliated Hospital of Zhengzhou University from July 2012 to December 2016 were prospectively analyzed. A randomized controlled study was performed based on a random number table. All patients were allocated into mini-mesh group and Kugel group. The outcomes including operative time, wound pain scores (1 week after operation), analgesic used, hospital stay after operation, urinary retention, wound infection, seroma, and femoral vein thrombosis were recorded. Patients were followed-up at 3 months, 1 year, and 2 years after operation. Follow-up data included chronic pain, foreign body feeling, quality of life, and recurrence.ResultsNinety-seven patients completed follow-up. There were 48 patients in the Kugel group and 49 patients in the mini-mesh group. The operation time of the mini-mesh group was significantly shorter than that of the Kugel group (P=0.030). There was no significant difference in analgesic used, hospital stay after operation, urinary retention, visual analog scale of wound pain at rest (VAS) 1 week postoperatively, and VAS of wound pain on coughing 1 week postoperatively between the two groups (P>0.05). No patient had wound infection, seroma or femoral vein thrombosis in the two groups. At 3 months, 1 year, and 2 years follow-up, there was no significant difference in chronic pain, foreign body feeling, and SF-36 score between the two groups (P>0.05). Ninety-seven patients completed 2 years follow-up, with no recurrence occurred during follow-up period.ConclusionsThe operative outcomes of mini-mesh repair are comparable to modified Kugel repair with a reduced operation time in femoral hernia patients. It is a safe and promising technique.
ObjectiveTo investigate the effectiveness of repair procedure using biological mesh with Onlay-Reinforce technique in patients with perineal hernia. MethodsBetween January 2005 and December 2012, 9 patients with perineal hernia after laparoscopic abdominoperineal resection for rectal cancer (Miles operation) were treated. There were 3males and 6 females with a mean age of 70 years (range, 61-78 years). The disease duration was 1-9 months (mean, 4.5 months). The most beginning symptom was distending pain in perineal region, and then reducible mass was found without bowel incarceration. All patients underwent hernia repair using biological mesh with Onlay-Reinforce technique through original perineal incision. ResultsThe hernial size was 9.8-20.5 cm2 (mean, 16.0 cm2); the size of biological mesh was 58-80 cm2 (mean, 70.2 cm2); and the intraoperative blood loss was 10-80 mL (mean, 50.5 mL). All of the patients underwent repair operation successfully. The operation time was 45-90 minutes (mean, 60.6 minutes); and the hospitalization time was 4-7 days (mean, 5.9 days). One patient had urine retention, which was relieved after 7 days indwelling catheter. All the wounds healed by first intention without infection. The patients were followed up 14.5-60.7 months (mean, 37.8months). No chronic pain, obvious foreign body sensation, or hernia recurrence developed. ConclusionUse of biological mesh with Onlay-Reinforce technique for the repair of perineal hernia after Miles operation is safe and effective.
ObjectiveTo evaluate the effectiveness of three-dimensional (3D) printing artificial vertebral body and interbody fusion Cage in anterior cervical disectomy and fusion (ACCF) combined with anterior cervical corpectomy and fusion (ACDF).MethodsThe clinical data of 29 patients with multilevel cervical spondylotic myelopathy who underwent ACCF combined with ACDF between May 2018 and December 2019 were retrospectively analyzed. Among them, 13 patients were treated with 3D printing artificial vertebral body and 3D printing Cage as 3D printing group and 16 patients with ordinary titanium mesh Cage (TMC) and Cage as TMC group. There was no significant difference in gender, age, surgical segment, Nurick grade, disease duration, and preoperative Japanese Orthopaedic Association (JOA) score, visual analogue scale (VAS) score, and Cobb angle of fusion segment between the two groups (P>0.05). The operation time, intraoperative blood loss, hospitalization stay, complications, and implant fusion at last follow-up were recorded and compared between the two groups; JOA score was used to evaluate neurological function before operation, immediately after operation, at 6 months after operation, and at last follow-up; VAS score was used to evaluate upper limb and neck pain. Cobb angle of fusion segment was measured and the difference between the last follow-up and the immediate after operation was calculated. The height of the anterior border (HAB) and the height of the posterior border (HPB) were measured immediately after operation, at 6 months after operation, and at last follow-up, and the subsidence of implant was calculated.ResultsThe operation time of 3D printing group was significantly less than that of TMC group (t=3.336, P=0.002); there was no significant difference in hospitalization stay and intraoperative blood loss between the two groups (P>0.05). All patients were followed up 12-19 months (mean, 16 months). There was no obvious complication in both groups. There were significant differences in JOA score, VAS score, and Cobb angle at each time point between the two groups (P<0.05). There was an interaction between time and group in the JOA score (F=3.705, P=0.025). With time, the increase in JOA score was different between the 3D printing group and the TMC group, and the increase in the 3D printing group was greater. There was no interaction between time and group in the VAS score (F=3.038, P=0.065), and there was no significant difference in the score at each time point between the two groups (F=0.173, P=0.681). The time of the Cobb angle interacted with the group (F=15.581, P=0.000). With time, the Cobb angle of the 3D printing group and the TMC group changed differently. Among them, the 3D printing group increased more and the TMC group decreased more. At last follow-up, there was no significant difference in the improvement rate of JOA score between the two groups (t=0.681, P=0.502), but the Cobb angle difference of the 3D printing group was significantly smaller than that of the TMC group (t=5.754, P=0.000). At last follow-up, the implant fusion rate of the 3D printing group and TMC group were 92.3% (12/13) and 87.5% (14/16), respectively, and the difference was not significant (P=1.000). The incidence of implant settlement in the 3D printing group and TMC group at 6 months after operation was 15.4% (2/13) and 18.8% (3/16), respectively, and at last follow-up were 30.8% (4/13) and 56.3% (9/16), respectively, the differences were not significant (P=1.000; P=0.264). The difference of HAB and the difference of HPB in the 3D printing group at 6 months after operation and last follow-up were significantly lower than those in the TMC group (P<0.05).ConclusionFor patients with multilevel cervical spondylotic myelopathy undergoing ACCF combined with ACDF, compared with TMC and Cage, 3D printing artificial vertebrae body and 3D printing Cage have the advantages of shorter operation time, better reduction of height loss of fusion vertebral body, and maintenance of cervical physiological curvature, the early effectiveness is better.
ObjectiveTo investigate the technique and early results of hybrid repair of parastomal hernia with the DynaMesh-IPST. MethodsA retrospective analysis was made on the clinical data of 28 patients who underwent DynaMesh-IPST hybrid repair of parastomal hernia between October 2013 and June 2016. There were 18 males and 10 females, aged 49-84 years (mean, 71 years). The disease duration of parastomal hernia was 6-60 months (mean, 27.6 months). The body mass index (BMI) was 17-35 (mean, 25.6); there were 15 obese patients (BMI > 26). ResultsThe operation was completed smoothly in all patients. The mean stoma diameter was 6 cm (range, 4-9 cm). The mean operation time was 142 minutes (range, 110-190 minutes). The mean hospital stay was 9 days (range, 7-12 days). Seroma was found in 2 patients, and was cured by needle aspiration and pressure bandage. All 28 cases were followed up 1-33 months (mean, 19 months). No recurrence, infection, intestinal fistula, and stoma-related problems were found. The appearance of abdominal wall was symmetrical. ConclusionDynaMesh-IPST hybrid repair is a safe and feasible method for parastomal hernia, and the short-term operative result is satisfactory.