Objective To evaluate the clinical experience and skills of laparoscopic totally extraperitoneal hernia repair with non-stapling of mesh and without using a balloon dissection in order to spread and popularize this kind of operation. Methods Under general anesthesia, 32 patients (42 sides) with inguinal hernias were repaired by laparoscopic totally extraperitoneal hernia repair with non-stapling of mesh and without using a dissection balloon from August 2005 to December 2007. Results All of operations were successfully performed. The operative time was 60-120 minutes, the blood loss was 20-60 ml, and the length of postoperative hospitalization was 3 days. All cases were followed up for 8 to 18 months and found no recurrence. Conclusion Laparoscopic totally extraperitoneal hernia repair with non-stapling of mesh and without using a balloon dissection is feasible, reliable and effective, offering a low recurrence rate, while its price is higher than tension-free herniorrhaphy by traditional method.
Objective To explore the effectiveness of tension-free herniorrhaphy with Ultrapro Plug (UPP) mesh through a femoris approach for femoral hernia repair. Methods Between March 2009 and January 2013, 123 patients (126 sides) underwent tension-free herniorrhaphy with UPP mesh through a femoris approach. There were 17 males and 106 females, aged 32-95 years (mean, 63.3 years). The locations were the left side in 48 cases, the right side in 72 cases, and both sides in 3 cases. The disease duration was 1 month to 26 years (median, 25 months). Of 123 cases, 35 cases (36 sides) were reducible and 88 cases (90 sides) were irreducible. According to American Society of Anesthesiologists (ASA) classification, 20 cases were rated as grade I, 42 cases as grade II, 56 cases as grade III, and 5 cases as grade IV. The operation time, postoperative hospitalization time, complication, recurrence, and chronic pain were recorded. Results The operation time was 7-28 minutes (mean, 14.5 minutes); postoperative hospitalization time was 2-96 hours (mean, 19.4 hours) (112 patients discharged from hospital within 24 hours). Wound dehiscence occurred in 1 case and fat liquefaction in 2 cases. A total of 119 patients (122 sides) were followed up 4-50 months (median, 18 months); no recurrence was noted. Two cases (2 sides) suffered from chronic pain after operation, whose visual analogue scale (VAS) was 20 mm and 30 mm, respectively. Conclusion Tension-free herniorrhaphy with UPP mesh through a femoris approach should be recommended because it has the advantages of simple operation, short operation time, less complication, and lower incidence of chronic pain.
目的：探讨3D网塞在腹股沟疝修补术中的应用。方法：随机选取30例腹股沟疝患者用3D网塞行无张力疝修补术。结果：本组平均手术时间35 min，平均术中出血15 mL。术后8~24 h下地活动，均未给镇痛药，无手术死亡、无切口感染、阴囊血肿等并发症，患者局部舒适性好，异物感不明显，随访5~10个月，无一例复发。结论：使用3D网塞作为充填式疝修补材料具有手术创伤小、恢复快，患者局部舒适性好，复发率低等优点。
Objective To explore the effectiveness of preperitoneal herniorrhaphy with Ultrapro Plug (UPP) mesh for umbilical hernia repair in adults. Methods Between September 2011 and June 2015, 71 patients with umbilical hernia underwent preperitoneal herniorrhaphy with UPP mesh. There were 26 males and 45 females, aged 19-92 years (mean, 54.3 years). The disease duration was 45 days to 30 years (median, 18 months). Umbilical hernia was diagnosed through physical examination, ultrasound, and other relevant auxiliary examination. According to American Society of Anesthesiologists (ASA) classification, 12 cases were rated as grade Ⅰ, 34 cases as grade Ⅱ, 21 cases as grade Ⅲ, and 4 cases as grade Ⅳ. The operation time, postoperative hospitalization time, complication, and recurrence were recorded. Results The diameter of hernia ring ranged 0.5-3.0 cm (mean, 1.8 cm). There was no vessel or intestine injury. The operation time was 12-35 minutes (mean, 22.4 minutes); postoperative hospitalization time was 12-48 hours (mean, 16.3 hours). Fat liquefaction of incision occurred in 2 cases, and primary healing of incision was obtained in the other cases. Sixty-nine patients were followed up 8-51 months (median, 28 months). Hernia recurrence and patch infection occurred in 1 case respectively during follow-up. No postoperative foreign body sensation and chronic pain occurred. Conclusion Repairing umbilical hernia in adults with UPP mesh should be safe and reliable, because it has the advantages of short operation time, short hospital stay, less complication, and lower incidence of recurrence.
Objective To investigate the optimal surgical approach for bilateral inguinal hernias and complex (recurrent and compound) inguinal hernia. Methods Data of eighty patients with bilateral inguinal hernias and (or) complex inguinal hernias treated by tension less hernia repair between Feb. 2007 and Jun. 2010 in Sichuan Provincial People’s Hospital were analyzed. Preperitoneal approach through inferior abdominal median incision was applied in the repair with local, lumbar or epidural anesthesia. Results Operation time was （30±10.2） min in unilateral hernia, （50±17.5） min in bilateral hernia. There was no ischemic orchitis or pain case after operation. Within 3 months following up, no recurrence occurred. Conclusion The preperitoneal approach through inferior abdominal median incision for inguinal hernia repair is proved to be effective, safe, and convenient, and especially fit for bilateral hernias and complex hernia.
目的评价疝环充填式无张力疝修补术治疗腹股沟嵌顿疝的临床效果。方法采用Bard Mesh perfix plug定型产品对12例腹股沟嵌顿疝患者施行疝环充填式无张力疝修补术，观察其疗效。结果2例肠坏死行小肠切除吻合术； 无术后死亡，12例均于术后1天下床活动。发生尿潴留2例。住院时间4～6 d。全部随访1～23个月，无复发。结论疝环充填式无张力疝修补术可应用于腹股沟嵌顿疝的治疗，且安全有效。
ObjectiveTo observe the effect of transabdominal preperitoneal (TAPP) laparoscopic hernia repair by same-day surgery mode for patients with inguinal hernia. MethodsThe patients who underwent TAPP laparoscopic hernia repair were retrospectively collected in the Day Surgery Center of West China Tianfu Hospital from July 2022 to June 2023. All patients in this study were admitted according to the same-day surgery plan, and those who were admitted to the hospital on the same day, operated on the same day, and returned to their homes on the same day, i.e., those who did not stay in the hospital overnight (the same-day surgery plan of the West China Tianfu Hospital of Sichuan University is now basically in the range of 8∶00–20∶00, and the latest discharge is at 21∶00) were classified as the same-day surgery group; however, the patients whose special cases needed to be postponed due to the condition of their illnesses, or those who were discharged from the hospital after 21∶00 due to safety considerations because of other reasons such as postoperative observation of patients with general anesthesia for a period of less than 2–4 h, or those who had a strong desire to be admitted to the hospital overnight, and whose hospital stay was not more than 24 h, were classified as the non-same-day surgery group. The age, gender, marital status, body mass index, hernia type, surgical site, home address, intraoperative bleeding, operative time, total hospitalization cost, pain score at discharge, unplanned revisit rate within 30 d after surgery, discharge satisfaction were compared between the patients of two groups. ResultsA total of 167 patients underwent TAPP laparoscopic hernia repair were enrolled in this study, including 97 in the same-day surgery group and 70 in the non-same-day surgery group. There were no statistically significant differences in the age, gender, marital status, body mass index, hernia type, surgical site, intraoperative bleeding, operative time, and total hospitalization cost between the two groups (P>0.05). However, it was found that the patients in the non-same-day surgery group had a higher pain score at discharge and a higher proportion of home address outside Chengdu city as compared with the same-day surgery group (P=0.042, P<0.001, respectively); The satisfaction rate of all patients in this group was 100% on the 28th day after discharge, and the unplanned revisit rate within 30 d after surgery was 3.6% (6/167), although which in the same-day surgery group was slightly higher than the non-same-day surgery group, the difference was not statistically significant by Fisher test [4.1% (4/97) versus 2.9% (2/70), P=0.226]. ConclusionFrom the analysis results of this study, TAPP laparoscopic hernia repair for patients with inguinal hernia by the same-day surgery mode is safe, and it can further shorten the hospitalization time as compared with the non-same-day surgery.
ObjectiveTo evaluate the clinical effectiveness and safety of platelet-rich plasma (PRP) in the arthroscopic repair of full-thickness rotator cuff injury.MethodsRelevant randomized controlled trials were identified from Cochrane Library, PubMed, Embase, China Biology Medicine Database, Chongqing VIP Database, China National Knowledge Infrastructure, and Wanfang Database (from the dates of establishment to September 2020). A systematic review was performed to compare the short-term and mid-term retear rates, the scores of the University of California at Los Angeles (UCLA) Shoulder Rating Scale, and the scores of Visual Analogue Scale (VAS) between the two groups. Analyses were conducted using RevMan 5.2.0 software.ResultsNine studies with low heterogeneity were included in the meta-analysis involving 610 cases (305 in the PRP group and 305 in the control group). There were significant differences in the short-term retear rate [relative risk (RR)=0.29, 95% confidence interval (CI) (0.13, 0.65), P=0.003], the short-term and the mid-term UCLA scores [standardized mean difference (SMD)=0.35, 95%CI (0.14, 0.56), P=0.000 9; SMD=0.87, 95%CI (0.53, 1.21), P<0.000 01], the short-term and the mid-term VAS scores [SMD=−0.29, 95%CI (−0.51, −0.07), P=0.009; SMD=−0.35, 95%CI (−0.66, −0.03), P=0.03] between the two groups. There was no significant difference in the mid-term retear rate [RR=0.88, 95%CI (0.48, 1.63), P=0.69] or complication rate [RR=1.40, 95%CI (0.78, 2.54), P=0.26] between the two groups.ConclusionsPRP injection can effectively improve the clinical outcomes following arthroscopic repair of full-thickness rotator cuff tears, thus reducing the short-term retear rate, alleviating pain, and improving patients’ shoulder function.
目的 探讨采用卵圆钳分离建立腹膜外间隙的腹腔镜完全腹膜外疝修补术（TEP）的临床应用体会和经验。方法 笔者所在医院2007年8月至2011年7月期间在硬膜外麻醉下采用卵圆钳分离建立腹膜外间隙对117例患者行免钉合改良TEP。结果 117例患者中行TEP 114例，中转腹腔镜腹膜前疝修补术（TAPP）3例。手术时间38～196min，平均单侧58.6min，双侧106.5min。住院时间2～10d，平均4.2d。主要并发症为阴囊积液或血清肿11例（9.4％），阴囊积气8例 （6.8％），无其他并发症发生。随访时间12个月，无复发及腹股沟区慢性疼痛等远期并发症发生。结论 卵圆钳分离建立腹膜外间隙的TEP是安全可行和经济实用的。