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 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 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.
Objective To evaluate the clinical application of the different operative approaches of the laparoscopicrepair of inguinal hernia and provide a more rational and scientific choice for the surgeon. Methods The strict inclusion and exclusion criteria were set up. All the randomized controlled trials （RCT） about laparoscopic transabdominal preperi-toneal （TAPP） and totally extraperitoneal （TEP） approaches of laparoscopic inguinal hernia repair were collected. Meta an-alysis was performed according to the recommendation by the Cochrane handbook. Results Seven RCTs including 552 patients were analyzed， who were divided into TAPP group （n=302） and TEP group （n=250）. Compared with TAPP group， there were no significant differences of the operation time〔WMD=8.49， 95% CI （-1.37， 18.35）， P=0.09〕， postoperative hospitalization〔SMD=0.11， 95% CI （-0.12， 0.34）， P=0.34〕， postoperative recurrence rate 〔OR=1.37， 95% CI （0.36， 5.20）， P=0.64〕， and complications （incision infection， urinary retention） 〔Incision infection：OR=4.27， 95% CI （0.85， 21.57）， P=0.08；Urinary retention：OR=0.61， 95% CI （0.21， 1.78）， P=0.36〕in the TEP group. But the postoperative 24 h pain in the TEP group was significantly milder than that in the TAPP group 〔WMD=0.72， 95% CI （0.58， 0.87）， P＜0.000 01〕. Conclusions The currently available evidence shows that postoperative 24 h pain in the TEP group is more milder than that in the TAPP group. The time of the operation， postoperative hospitalization， postoperative recurrence， and complications are no significant differences between TAPP group and TEP group. Large-scale， high-quality RCTs are still needed to confirm or refuse the available evidence.
OBJECTIVE: To investigate the repairing method of inguinal scar contracture deformity in children with transpositional fasciocutaneous flap of anterior-medial side of thigh. METHODS: From August 1989 to August 1999, 33 cases with inguinal scar contracture deformity were adopted in this study. Among them, there were 26 males and 7 females, aged from 3 to 11 years old. The transpositional fasciocutaneous flap consisted of a huge tongue-shape flap with a pedicled triangular flap between the edge of skin defect and the above tongue-shape flap. The maximal size of the transpositional fasciocutaneous flap was 18 cm x 10 cm and the minimal size was 13 cm x 8 cm, the transpositional angle was 60 degrees to 80 degrees. During operation, the tongue-shape flap was used to repair the inguinal region and the triangular flap was used to repair the donor site in one stage. RESULTS: All the flaps survived. The function and appearance of perineum were satisfactory. CONCLUSION: The transpositional fasciocutaneous flap is suitable for repairing the inguinal scar contracture deformity in children, and skin graft is unnecessary.
ObjectiveTo investigate the clinical value of veress needle with thread for laparoscopic high ligation of hernia sac in children. MethodsThe clinical data of 56 cases of pediatric inguinal hernia using laparoscopic high ligation of hernia sac with veress needle from May 2013 to May 2014 were analyzed retrospectively. ResultsAll patients were successfully carried out operation by laparoscopic high ligation of hernia sac.Forty-one cases underwent unilateral surgery, and operative time was 6-18 min (mean 9.6 min); 15 cases underwent bilateral surgery, and operative time was 10-32 min (mean 14.3 min).Nine cases of contralateral recessive hernia were found and ligated during operation.There was no complications, such as scrotal edema, scrotal gas or incision infection after operation, and all patients were discharged in l-2 days after operation.No recurrence or testicular dysplasia was found during 3 to 15 months (mean 10.8 months) follow-up. ConclusionsThere are many advantages in laparoscopic high ligation of hernia sac with veress needle, such as less damage, hidden incision, faster recovery, shorter hospital stay, simple operation, and better efficacy.We can find contralateral recessive hernia during operation and avoid second surgery with high clinical value, therefore it is worthy of clinical application.
ObjectiveTo develop a machine learning model to identify preoperative, intraoperative, and postoperative high-risk factors of laparoscopic inguinal hernia repair (LHR) and to predict recurrent hernia. Methods The patients after LHR from 2010 to 2018 were included. Twenty-nine characteristic variables were collected, including patient demographic characteristics, chronic medical history, laboratory test characteristics, surgical information, and postoperative status of the patients. Four machine learning algorithms, including extreme gradient boosting (XGBoost), random forest (RF), support vector machine (SVM), and k-nearest neighbor algorithm (KNN), were used to construct the model. We also applied Shapley additive explanation (SHAP) for visual interpretation of the model and evaluated the model using the k-fold cross-validation method, receiver operating characteristic (ROC) curves, calibration curves, and decision curve analysis (DCA). ResultsA total of 1 178 patients with inguinal hernias were included in the study, including 114 patients with recurrent hernias. The XGBoost algorithm showed the best performance among the four prediction models. The ROC curve results showed that the area under the curve (AUC) value of XGBoost was 0.985 in the training set and 0.917 in the validation set, which showed high prediction accuracy. The K-fold cross-validation method, calibration curve, and DCA curve showed that the XGBoost model was stable and clinically useful. The AUC value in the independent validation set was 0.86, indicating that the XGBoost prediction model has good extrapolation. The results of SHAP analysis showed that mesh size, mesh fixtion, diabetes, hypoproteinemia, obesity, smoking history, low intraoperative percutaneous arterial oxygen saturation (SpO2), and low intraoperative body temperature were strongly associated with recurrent hernia. ConclusionThe predictive model of recurrent hernia after LHR in patients derived from the XGBoost machine learning algorithm in this study can assist clinicians in clinical decision making.
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 important role of preperitoneal space in laparoscopic transabdominal preperitoneal （TAPP） and totally extraperitoneal （TEP） hernia repair. Methods The clinical data of 66 patients （78 sides） performed laparoscopic TAPP and TEP hernia repair from January 2008 to April 2011 in this hospital were analyzed retrospectively. Results TAPP hernia repair were performed in 16 cases （20 sides），TEP hernia repair were performed in 50 cases （58 sides）. Three cases of TEP hernia repair transferred to TAPP hernia repair. The unilateral operation time was （86.92±36.38） min，intraoperative bleeding was （6.08±3.43） ml. Postoperative complication rate was 16.7% （11/66），including 3 cases of postoperative serum swelling，3 cases of temporary paraesthesia of nerve feeling in the repair area，2 cases of scrotum emphysema，2 cases of urinary retention，and 1 case of intestinal obstruction. There were 2 cases of recurrence. The hospital stay was （4.52±0.99） d. The return to activities and working time was （10.32±1.86） d after discharge. Sixty-six cases were followed up for （18.56±1.96） months （range 1-38 months），the patch infection，chronic pain，and testicular atrophy complications were not been observed. Conclusions Acquainting and mastering laparoscopic preperitoneal space and its important structure are the key to avoid intraoperative and postoperative complications of laparoscopic inguinal hernia repair.
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.