Objective To investigate the application of transverse fascia in inguinal hernia repair. Methods In this study, 617 patients underwent inguinal hernia repair between January 1990 and December 2005 in our hospital were included, which were divided into two groups according to different operative ways: transverse fascia method group (n=337) and Bassini method group (n=280). Then intraoperative results, postoperative complications, and rehabilitated results of patients in two groups were compared. Results Compared with Bassini method group, the patients in transverse fascia method group did not show significant difference in operative time and blood loss during operation (Pgt;0.05). The differences of severe postoperative pain, testicular swelling, the time of the body’s restore for normal activities, and recurrence rate of patients between two groups were significant (Plt;0.05), while the difference of hematoma of scrotum and infection of incisional wound (Pgt;0.05). Conclusion The strengthening of posterior wall by transverse fascia and reconstruction of inner ring is a simple and effective method for inguinal hernia repair.
ObjectiveTo compare the efficiency of total extraperitoneal inguinal herniorrhaphy with laparoscopic technique using an innovative self-gripping mesh and polypropylene mesh. MethodsThe clinical data of 142 cases of unilateral inguinal hernia who underwent total extraperitoneal prosthesis (TEP) in our hospital form June 2012 to March 2015 were retrospectively analyzed. the operation type was total extraperitoneal inguinal herniorrhaphy with laparoscopic technique. Depending on the kind of mesh, all patients were divided into two groups from the self-gripping mesh group (n=60) and the polypropylene mesh group (n=82). ResultsThere was no significant difference in the operation time, intraoperative blood loss, hospital stay, and The Visual Analogue Score of post-operative (at 12, 24, 48, and 72 hours after operation) between the 2 groups (P>0.05). On the post-operative complications, there was no significant difference in incidences of total complication, scrotal edema, seroma, bladder injury, vascular injury of abdominal, and urinary reten-tion too (P>0.05). All the patients were followed up for 3-36 months (the median time was 19-month), and no recurrence occurred during the follow-up period. ConclusionInnovative self-gripping mesh is safe and effective, and maybe a good direction of mesh for material development.
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.
ObjectiveTo compare the clinical effect of total extraperitoneal inguinal herniorrhaphy (TEP) with open and laparoscopic technique. MethodsThe clinical data of 148 patients with inguinal hernia or femoral hernia in this hospital from January 2012 to July 2013 were analyzed retrospectively, in which 74 patients received TEP with open technique (open TEP group), 74 patients received TEP with laparoscopic technique (laparoscopic TEP group). ResultsAll the operations were successfully completed.Compared with the laparoscopic TEP group, the operative time, intra-operative bleeding, and hospitalization expenses were significantly decreased in the open TEP group (P < 0.05).The post-operative exhaust time, postoperative hospital stay, and the postoperative complications rate had no significant differences between the open TEP group and the laparoscopic TEP group (P > 0.05).All the patients were followed up, no recurr-ence occurred during a 3-19 months of following-up. ConclusionsTEP with open and laparoscopic technique are both safe and efficient.The open technique has the advantages of shorter operative time, lower cost, so it is worth being widely used for primary hospital.
ObjectiveTo compare degree and characteristics of early postoperative pain for patients with inguinal hernia underwent laparoscopic versus open tension-free hernioplasty. MethodsThe clinical data of 120 patients who underwent tension-free hernioplasty from July 2013 to June 2015 were analyzed. All of the patients were divided into open tension-free hernioplasty group (open group, n=60) and laparoscopic tension-free hernioplasty group (laparoscope group, n=60). Visual analogue scale (VAS) score was evaluated at different time point. Results① Within 12 h after operation, the comparison of total VAS score between the laparoscope group and the open group had no significant difference (F=1.674, P=0.198), the difference of VAS score in these two groups was significantly different at each time point (F=21.186, P=0.000), and the variation tendency was influenced by grouping factors (F=87.038, P=0.000). ② Within 7 d after opera-tion, the differences of comparison of total VAS score between the laparoscope group and the open group and at each time point were statistically significant (F=46.358, P=0.000; F=576.387, P=0.000) and had a downtrend, further more the variation tendency was influenced by grouping factors (F=19.454, P=0.000). ③ The composition ratios of pain site and characteristics had significant differences between these two groups within 7d after operation (χ2=10.108, P=0.001; χ2=7.144, P=0.028), the dosage of analgesic drugs between two groups had no significant difference (t=0.872, P=0.386). ConclusionAs a representative of minimally invasive surgery, laparoscopic technology has certain advantages in reducing postoperative pain for patients with inguinal hernia, but minimally invasive technique does not mean to painless. Further improvement is needed by hernia surgery.
ObjectiveTo evaluate the safety and efficiency of perioperative low molecular heparin (LMH) as the replacement of anticoagulant for patients with inguinal hernia. MethodsSixty-three patients with oblique inguinal hernia from April 2009 to April 2012 in this hospital were analyzed retrospectively.Seventeen cases because of other diseases were long-term oral aspirin anticoagulant therapy (aspirin group), 11 cases because of other diseases were long-term oral warfarin anticoagulant therapy (warfarin group), anticoagulant therapy was replaced by continuing LMH 7 d before operation in the aspirin group and the warfarin group.The other 35 cases did not take any anticoagulant therapy (control group). Results①The demography and preoperative international normalized ratio were similar among three groups (P > 0.05).②All the patients were followed-up.The duration of follow-up ranged from 12 months to 18 months.There were no statistical differences of the scrotal hematoma or subcutaneous hematoma, operation time, postoperative hospital stay, and VAS scoring among these three groups (P > 0.05).There was no recurrence in all the patients. ConclusionFor a long term application of anticoagulant in patients with oblique inguinal hernia, perioperative application of LMH instead of anticoagulant does not increase the risk of bleeding, and could prevent thrombosis.
ObjectiveTo investigate the application of tension-free herniarepair under local anesthesia in senile inguinal hernia. MethodsClinical data of 163 cases of senile inguinal hernias with herniorrhaphy under local anesthesia in our department from October 2011 to October 2014 were analyzed retrospectively, including epidural anesthesia 90 patients and local anesthesia 73 patients. ResultsAll patients were successfully completed surgery. Hospital charges in local anesthesia were much cheaper than that in epidural anesthesia group (P=0.002). Hospital days in local anesthesia were much shorter than that in epidural anesthesia group (P=0.035). Lung complication in local anesthesia were much less than that in epidural anesthesia group (P=0.015). Other indicators were no significant difference between the two groups (P > 0.05). ConclusionTension-free herniorrhaphy under local anesthesia in elderly patients is safe, reliable, less invasive method with low costs, slight postoperative pain, and worthy of promotion.
ObjectiveTo survey the feasibility of laparoscopic high ligation for pediatric inguinal hernias by performing the surgery on rabbit models. MethodsLaparoscopic high ligation was operated on 32 healthy New-Zealand male rabbits. Eight random rabbits were observed under laparoscope on the 7th, 15th, 30th, and 60th days after operation, and the anti-tension strength at the instant when hernial inner ring cracked was measured. Repair regions were resected. After HE-staining, the syzygial status of the repair regions were checked. ResultsNone of the rabbits died during the research with no such complications as ankylenteron intestinal obstruction or hernia relapses after surgery. The anti-tension strength by the inguinal regions of the experimental rabbits after surgery on the 7th, 15th, 30th, and 60th days was respectively (42.69±6.98), (69.31±6.52), (102.64±7.91), and (106.53±7.54) mm Hg (1 mm Hg=0.133 kPa). As for the pathological section observation, the agglutination of the repair region was consistent with reparative process of chronic nonbacterial inflammation. ConclusionThe operation of laparoscopic high ligation for repairing inguinal hernia on rabbits is safe and reliable.
ObjectiveTo study the efficacy, the operation skills, and the complications of laparoscopic totally extraperitoneal prosthesis (TEP). MethodsThe clinical data of 1 020 patients received TEP from April 2011 to March 2014 were retrospectively analyzed. The oral feeding time, out of bet time, operation time, hospital stay, hospitalization costs, postoperative complications, and so on were recorded. ResultsAmong the 1 020 patients, the types of hernias were 810 indirect inguinal hernias (including unilateral hernia and bilateral hernia), 118 direct inguinal hernias, 24 femoral hernias, and 68 recurrent inguinal hernias. The surgeries were basically successfully completed in all the patients, including 12 cases (both recurrent hernia) of conversion to laparoscopic transabdominal preperitoneal prosthesis (TAPP). All the patients could take food in a day and get out of bed on day 1 after operation. The unilateral operation time was (48±9.8) min, bilateral was (65±8.6) min. The postoperative hospital stay was 0.5-2.0 d, total hospital stay was (3.48±2.40) d, hospitalization costs was (8 958±1 685) yuan. Main complication was 61 (5.98%) cases of seroma, 48 (4.70%) cases of temporary nerve paresthesia, 23 (2.78%) cases of urinary retention, 9 (0.88%) cases of chronic pain, and 5 (0.49%) cases of abdominal artery injury. No incision infection, visceral injury, small intestinal obstruction, and other serious complications happened. No occurrence occurred with following-up for 1 year. Classification of different hernia complications, the statistical analysis showed that the total incidence of complications of the typeⅣwas highest, then which was in sequence of typeⅢ, typeⅡ, typeⅠ(P < 0.001). ConclusionLaparoscopic TEP is a safe, reasonable repair without tension with small incision, lighter abdominal interference, less pain, early return to normal activities, but it is a difficult technology and has a higher cost.
Objective To compare the postoperative outcomes of elderly and non-elderly patients undergoing inguinal hernia repair in same-day surgery mode, and explore the utility and safety of same-day surgery mode in inguinal hernia repair. Methods Patients who underwent inguinal hernia repair in Day Surgery Center, West China Hospital of Sichuan University between January 1st 2021 and October 31st 2021 were prospectively included. The patients were divided into elderly group (≥60 years old) and non-elderly group (18-59 years old). The preoperative conditions, postoperative outcomes, discharge readiness and social support of the two groups were analyzed. Results A total of 451 patients were enrolled, including 111 elderly patients and 340 non-elderly patients. The male proportion, prevalence rates of preoperative comorbidities, and bilateral inguinal hernia proportion in the elderly group were significantly higher than those in the non-elderly group (P<0.05), and the body mass index in the elderly group were significantly lower than that in the non-elderly group (P<0.05). There was no significant difference in anesthesia method, analgesic method, bleeding volume, or surgery time between the two groups (P>0.05). The postoperative pain score of the non-elderly group was higher than that in the elderly group (Z=–2.226, P=0.026), but there was no statistically significant difference in the rate of postoperative unplanned analgesia, rate of discharge delay, pain score on the third day after discharge, re-consultation within one month after discharge, complications within one month after discharge, or post-discharge satisfaction (P>0.05). The total score of social support was higher in the elderly group than that in the non-elderly group (31.77±3.04 vs. 29.75±4.78; t=4.182, P<0.001). Conclusion The same-day surgery mode for inguinal hernia repair is feasible and safe in elderly patients and worthy of implementation.