Objective To evaluate the effectiveness of inguinal hernia treated by tension-free hernioplasty in adult. Methods Electronic databases were searched including CNKI (1993 to 2003), MEDLINE (1993 to 2003) and OVID (1993 to 2003). Personal contact with experts in the field of tension-free hernioplasty was performed to identify potentially relevant trials. Randomized controlled trials of plug amp; Mesh versus Mesh only repair and laparoscopic versus open Mesh hernia repair in recurrence, peri-operative complication or long term postoperative complication were included. Data related to the clinical outcome were extracted by two reviewers independently. Statistical analysis was performed by using RevMan 4.2 software. Results Twenty one studies involving 4 154 patients met the inclusion criteria from 1993 to 2003. Compared with Mesh only repair, plug amp; Mesh repair had no significant difference in recurrence rate (OR 1.14, 95%CI 0.37 to 3.47, P=0.82), preoperative complication rate (OR 1.01, 95%CI 0.63 to 1.63, P=0.95) and long term postoperative complication rate (OR 0.46, 95%CI 0.18 to 1.16, P=0.1). Compared with open Mesh hernioplasty, transabdominal preperitoreal repair (TAPP) group had no significant difference in recurrence rate (OR1.24, 95%CI 0.65 to 2.36, P=0.52), preoperative complication rate (OR 0.89, 95%CI 0.65 to 1.22, P=0.46) and persistent pain (OR 0.76, 95%CI 0.48 to 1.19, P=0.22); totally extrapevitoreal repair (TEP) group had no significant difference in recurrence rate (OR1.07, 95%CI 0.51 to 2.24, P=0.70) or persistent pain (OR 0.95, 95%CI 0.55 to 1.65, P=0.86), and had lower tendency persistent pain (OR 0.50, 95%CI 0.34 to 0.73, P=0.000 4) with statistical significance. Conclusion Current evidence suggests that there is no significant difference between anterior approach plug amp; Mesh repair (Rutkow’s repair) and the Mesh only repair (Lichtenstein’s repair). TEP of Laparoscopic hernioplasty is superior to open Mesh hernia repair in preoperative complication. More researches are needed for recurrence rate, persistent pain.
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.
Objective To explore the cause and treatment of chronic pain after tension-free repair of inguinal hernia. Methods 〗The clinical data of 426 cases with inguinal hernia underwent the tension-free hernioplasty during February 2002 to September 2007 were retrospectively analyzed. Results 〗Tension-free hernioplasty was performed to all patients. According to operative methods, they were divided into two groups: polypropylene filling group (n=210) and expanded polytetrafluoroethylene (e-PTFE) mycromesh group (n=216). The chronic pain rate after operation, polypropylene filling group (9.0%, 19/210) was significantly higher than e-PTFE mycromesh group (4.2%, 9/216)， P＜0.05. Conclusion 〗The tension-free repair by e-PTFE mycromesh has less pain in the inguinal hernia due to the material is more suitable to human physiology, more soft and light, with less complications.
Objective To investigate the most suitable anaesthesia method for the tension-free herniorrhaphy.Methods A total of 422 unilateral inguinal hernia cases from 2002 to 2005 were collected and randomly divided into the local anaesthesia group and epidural anaesthesia group. Observation indices and some relative data, such as operative duration, date of ambulation, date of foodintake, length of hospital stay, operation-correlated complications, anaesthesia complications, usage rate of ancillary drug, satisfactory rate for anesthesia, cost of hospitalization, were included and recorded in the questionnaire, and all the patients who took the tension-free herniorrhaphy were asked to answer it as the follow-up research. Results It was found that the occurrence of postoperative anaesthetic complications, the cost of hospitalization, length of stay of local anaesthesia group were significantly less than those of epidural anaesthesia group, and the date of moving and the date of foodintake were also significantly earlier than those of the other group (P＜0.05). However, there was no significant difference of operative duration, postoperative recovery situation and the satisfactory rate between two groups (P＞0.05).Conclusion The local anaesthesia is suitable for most of the tension-free herniorrhaphy, and it may be used as the conventional anaesthetic method.
Objective To investigate the indication, approaches andpreventionof complications in treatment of female stress urinary incontinence(SUI) with tension-free vaginal tape (TVT). Methods From September 2003 to December 2004, 40 cases of female stress urinary incontinence were treated, including 8 cases in association with cystocele or rectocele and 1 case in association with uterine prolapse. They ranged from 30 to 70 years in age with an average of 56.3years. The disease course was 1.42 years(7.2 years on average). All patients received TVT. In the patients suffering from uterine prolapse and cystocele or rectocele, butterfly-shaped mesh patch was applied. Results All patients achieved satisfactory results.The complications included slight dysuria(2 cases),vesical perforation(1 case) and pelvic hematoma(1 case) and cleared up after treating. All cases were followed up 1 to 15 months and the results were satisfactory. No urinary incontinence and no dysuria reoccurred. Conclusion TVT is effective for SUI.
ObjectiveTo compare the clinical outcome of tension-free vaginal tape (TVT) and TVT-obturator (TVT-O) for female stress urinary incontinence (SUI). MethodsSixty-one female SUI patients were included in our study, in which 33 received TVT procedure and 28 received TVT-O procedure. The patients were followed up for 1 to 62 months post-operatively, averaging at 22 months. Cure was defined as no leakage during the stress test and no residual urine showed by B ultrasound, improvement as less leakage during the stress test after operation, and inefficacy as leakage during the stress test and no difference was detected after operation. ResultsAge and disease course were not significantly different between the two groups (P>0.05). All patients underwent TVT or TVT-O procedure successfully. Time of TVT ranged from 26 to 45 min averaging at (35.5±4.3) minutes, and it was significantly different from the time of TVT-O which ranged from 15 to 20 min averaging at (7.2±3.1) minutes (P<0.05). Bleeding during the surgery was not significantly different between the two groups (P>0.05). The rate of complications occurring during TVT-O procedure was significantly less and milder than that during the TVT procedure (P<0.05). The cure rate and improvement rate indicated no significant differences between the two groups (P>0.05). ConclusionThe evidence available indicates that TVT and TVT-O procedure are both effective and safe for female SUI. Compared with TVT, TVT-O procedure has the advantages of being more convenient, shorter operation time, being less invasive, and fewer complications, and it may be more suitable for female SUI.
Objective To evaluate the clinical effect of Easy Prosthesis D-10 on open preperitoneal groin tension-free hernioplasty. Methods The operative time, operation-correlated complications, hospital stay and recent follow-up findings of 63 patients underwent preperitoneal groin tension-free hernioplasty were analyzed from October 2006 to April 2008. Results No case died in perioperative period. The average operative time was (47.6±10.5) minutes. None of incision infection and scrotal hydrocele occurred. The average hospital stay was (7.7±2.1) days. During follow-up period of 6 to 24 months, no recurrence, chronic pain and foreign body sensation were found. Conclusion The open preperioneal groin tension-free hernioplasty by Easy Prosthesis D-10 is safe and reliable, especially for the inguinal hernia with large hernia ring or defect of transversalis fascia and recurrent hernia.
Objective To summary the experience of transabdominal preperitoneal space tension-free repair for inguinal saddle hernia. Methods 〗The clinical data of 151 cases of inguinal saddle hernias underwent transabdominal preperitoneal space tension-free repair with Prolene hernia system (PHS) were retrospectively analyzed. The operative time, postoperative pain, hospital stay, recurrence and postoperative complications were observed. Results The average operative time in unilateral hernias was (29.8±9.6) min. Postoperative complications included one case of pain in groin and 4 cases of scrotum edema. No incision infection and mortality occurred. Postoperative duration of hospital stay was 3 to 5 days. All cases were followed up for 1-5 years and no recurrence happened. Conclusion 〗Transabdominal preperitoneal space tension-free repair for inguinal saddle hernia by PHS is safe and reliable.
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 explore the surgical effect and cost-effectiveness of day surgery versus inpatient surgery for tension-free herniorrhaphy. MethodsA total of 100 cases of unilateral inguinal hernia who treated in West China Hospital of Sichuan University from Jan. 2010 to Sep. 2010 were collected prospectively, and were randomly divided into 2 groups: day surgery group (50 cases) and inpatient surgery group (50 cases). Comparison of the surgical effect and cost-effectiveness of day surgery versus inpatient surgery was performed. ResultsThere was no significant difference in the operation time, blood loss during the operation, incidence of urinary retention, scrotal edema fluid, incision foreign body sensation, and total complications, the time of get out of bed after surgery, and the time of returning to work after surgery (P > 0.05), but the hospital stay of day surgery group was shorter than that of inpatient surgery group (P < 0.05). The total cost of day surgery group was lower than that of inpatient surgery group (P < 0.05). There was no significant difference in the preoperation cost and introperative cost (P > 0.05), but the postoperative cost of day surgery group was lower than that of inpatient surgery group (P < 0.05). In the preoperation cost, there was no significant difference in the intraoperative monitoring fee, anesthesia and surgery materials fee, and drug charges (P > 0.05), but in the postoperative cost, the drug charges, nursing care fee, bed fee, and escort fee of day surgery group were all lower than that of inpatient surgery group (P < 0.05). ConclusionsThe effect of day surgery for tension-free herniorrhaphy is similar with inpatient surgery. But compared with inpatient surgery, the total cost of day surgery is lower, turn-over rate is higher, so it improves utilization of medical resources, reduces economic burden, and also reduces the medical burden of the country.