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 review the clinical operation methods of abdominal incisional hernia. Methods Classification, operation method and fellow-up of 78 patients with abdominal incisional hernia were retrospectively analyzed. Results The average time of fellow-up was 26 months. Nineteen cases were repaired with simple suture with 3 cases (15.8%) recurrence, 57 cases were repaired with man-made material with 2 case （3.4%） recurrence. Conclusions Individual operation method should be chosen according to body condition, classification of the size of abdominal loss and abdominal hypertension. It is an effective method to repair the hernia of abdominal incision with man-made material.
Objective To study anatomy of mortis corona vascular and analyze its characteristics and clinical significances in laparoscopic total extraperitoneal hernia repair (TEP). Method The clinical data of 45 patients with inguinal hernia underwent laparoscopic TEP from July 2013 to October 2015 in the Fourth People’s Hospital of Zigong City were collected. Results ① There were 45 patients with inguinal hernia a total of 52 bilateral inguinal hernias (15 direct hernias, 37 oblique hernias). The total appear rate of corona mortis vascular was 61.5% (32/52). The appear rate of corona mortis artery was significantly higher than that of the corona mortis vein〔46.2% (24/52)versus 34.6% (18/52),P<0.05〕, the diameter of the corona mortis artery was significantly smaller than that of the corona mortis vein〔(3.2±0.3) mmversus (3.4±0.4) mm,t=2.231,P<0.05〕. ② The appear rates of corona mortis artery and vein in the male patients were significantly higher than those of the female patients (P<0.05). Compared with the female patients, the age of onset was older (P<0.05), thickness of abdominal wall was thinner (P<0.05), diameter of corona mortis vascular was bigger (P<0.05) in the male patients. ③ The total appear rate of corona mortis vascular in the patients with direct hernia was significantly lower than that of the patients with oblique hernia (P<0.05). The age of onset of the patients with direct hernia was significantly older than that of the patients with oblique hernia (P<0.05). Conclusions There is a higher appear rate of corona mortis vascular in patients with oblique hernia, which in male patients is higher as compared with female patients. Age of onset of male patient with inguinal hernia is older than that of female patient with inguinal hernia. It suggests that appear of corona mortis vascular might be associated with degeneration of abdominal wall. It has a certain role for localization and avoidance of corona mortis vascular in TEP.
ObjectiveTo compare the properties of hernia repair mesh of different materials used in clinical practice, so as to provide reference for clinical selection of numerous meshes at present. MethodThe literatures of different materials of hernia mesh in the treatment of abdominal hernia and inguinal hernia at home and abroad were reviewed.ResultsThe synthetic mesh, especially the polypropylene mesh with wide-pore mesh in the midweight mesh, might be the most ideal synthetic mesh. The new coating material improved the defect of polypropylene material to a great extent. The status of biological mesh in complex hernia repair had been waxed, and it had a tendency to be replaced by absorbable synthetic mesh.ConclusionsCurrently, there is no single mesh suitable for all types of hernia repair. Polypropylene mesh is still an effective and low cost mesh material, and there may be more room for the development of absorbable synthetic materials and antimicrobial coatings.
ObjectiveTo explore the effectiveness of traditional Chinese medicine (TCM) acupuncture analgesia after laparoscopic total extraperitoneal inguinal hernia repair (TEP), aiming to reduce the use of analgesics post-surgery. MethodsPatients who underwent unilateral TEP in the Department of Hernia and Abdominal Wall Surgery at our hospital from May 2022 to May 2023 were selected as research subjects. Those who met the inclusion and exclusion criterias were randomly assigned to three groups: TCM acupuncture analgesia group, traditional Chinese medicine acupuncture analgesia plus western medicine analgesia group (referred to as Chinese and western medicine analgesia group), and western medicine analgesia group. The basic information, postoperative numerical rating scale (NRS) pain scores, postoperative recovery indicators, and complication rates of the three groups were analyzed and compared.ResultsThere was no statistically significant differences in the basic data of patients across the three groups (P>0.05). There were significant differences in NRS score, recovery time of intestinal function, first urination time after operation and first ambulation time after operation at each time point after analgesia (6 h, the next morning, 48 h, 72 h and 96 h after operation) among the three groups (P<0.05). The NRS scores in both the TCM acupuncture analgesia group and the Chinese and western medicine analgesia group were lower than those in the western medicine analgesia group (P<0.05), Additionally, postoperative recovery outcomes were better in the TCM acupuncture analgesia group and the Chinese and western medicine analgesia group compared with the western medicine group (P<0.05). There was no significant difference of the above results compared between the TCM acupuncture analgesia group and the Chinese and western medicine analgesia group (P>0.05). There was no significant difference in postoperative complications among the three groups (P>0.05). ConclusionTCM acupuncture analgesia following TEP surgery is effective and leads to improved postoperative recovery compared with the use of oral analgesics alone, without an increase in adverse reactions.
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.
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 investigate the relation between preoperative peripheral blood neutrophil/albumin (NEU/ALB) or hypersensitive C-reactive protein (hs-CRP)/ALB ratio and seroma after laparoscopic transabdominal preperitoneal (LTAPP) hernia repair. MethodsThe patients diagnosed with inguinal hernia and underwent LTAPP hernia repair admitted to the Heji Hospital Affiliated to Changzhi Medical College from June 2020 to June 2023 were retrospectively collected. The multivariate logistic regression analysis was conducted to identify the risk factors affecting the occurrence of seroma after LTAPP hernia repair. The area under receiver operating characteristic curve (AUC) and 95% confidence interval (95%CI) were used to evaluate the discriminatory value of preoperative peripheral blood NEU/ALB ratio and hs-CRP/ALB ratio for seroma after LTAPP hernia repair. Delong test was used to compare the discriminatory value of these indicators. The test level was α=0.05. ResultsA total of 357 patients who met the inclusion criteria were included in this study, and the seroma occurred in 42 cases (11.8%). The results of multivariate logistic regression analysis showed that the larger the diameter of the hernia sac [OR (95%CI)=4.654 (2.829, 7.657), P<0.001], the more intraoperative bleeding [OR (95%CI)=3.021 (1.498, 6.094), P=0.002], and the higher NEU/ALB ratio [OR (95%CI)=2.585 (1.618, 4.130), P<0.001] or hs-CRP/ALB ratio [OR (95%CI)=1.874 (1.239, 2.834), P=0.003], the higher the probability of seroma after LTAPP hernia repair. The AUC (95%CI) of NEU/ALB or hs-CRP/ALB indicator for predicting seroma after LTAPP hernia repair was 0.750 (0.702, 0.794) and 0.762 (0.715, 0.806), respectively. The optimal cutoff values were 2.970 and 4.001, with sensitivity of 78.6% and 73.8%, and specificity of 60.3% and 65.7%, respectively. The AUC (95%CI) of the NEU/ALB in combination with hs-CRP/ALB in predicting seroma after LTAPP hernia repair was 0.851 (0.810, 0.886), with sensitivity and specificity of 71.4% and 87.0%, respectively. The AUC of the NEU/ALB in combination with hs-CRP/ALB in predicting seroma after LTAPP hernia repair was higher than that of NEU/ALB (Z=2.864, P=0.004) or hs-CRP/ALB alone (Z=2.956, P=0.003). ConclusionFrom the data analysis results of this study, the occurrence rate of seroma after LTAPP hernia repair is not low, and the occurrence of seroma should be paid close attention to patients with larger hernia sac diameter, more intraoperative bleeding, and higher NEU/ALB or hs-CRP/ALB ratio.
Objective To evaluate the clinical effectiveness and safety of different mesh fixation techniques in laparoscopic trans-abdominal preperitoneal hernia repair (TAPP) by using network meta-analysis. Methods CNKI, WanFang Data, VIP, CBM, the Cochrane Library, PubMed, Embase, and Web of Science databases were retrieved to collect randomized controlled trials (RCTs) studies comparing different fixation methods of patches in laparoscopic TAPP. The retrieval time limit was from the establishment of the database to March 1, 2022. After two researchers independently screened the literatures, extracted the data, and evaluated the bias risk, Bayesian network meta-analysis was conducted by using R4.1.2 software. Results Twenty-nine RCTs were included, including 4 095 patients. The results of network meta-analysis showed that the risk of chronic postoperative inguinal pain was higher in staples fixation than that of no fixation [OR=0.06, 95%CI (0.01, 0.26), P＜0.001], glue fixation [OR=0.21, 95%CI (0.04, 0.53), P=0.001] and self-gripping mesh [OR=0.09, 95%CI (0.01, 0.52), P=0.009], the incidence of chronic postoperative inguinal pain with suture fixation was higher than that with no fixation [OR=0.10, 95%CI (0.01, 0.70), P= 0.020]. Postoperative visual analogue scale of staples fixation was higher than those of no fixation [MD=–0.90, 95%CI (–1.49, –0.33), P=0.002] and glue fixation [MD=–0.92, 95%CI (–1.35, –0.49), P＜0.001], the postoperative visual analogue scale with suture fixation was higher than those of no fixation [MD=–0.83, 95%CI (–1.61, –0.08), P=0.030] and glue fixation [MD=–0.85, 95%CI (–1.56, –0.13), P=0.020]. There was no significant difference in the incidence of seroma and hematoma, hospital stay and hernia recurrence among different fixation methods. Conclusions The network meta-analysis shows that medical glue and self-gripping mesh have certain advantages in reducing chronic pain after surgery, which may be the better patch fixation method in TAPP. The non fixation mesh will not increase the risk of postoperative recurrence, and can be used in clinical practice. This conclusion needs to be further verified by large sample, long-term follow-up and high-quality RCTs.
Objective To explore the surgical techniques and the clinical effect of laparoscopic transabdominal preperitoneal （TAPP） hernia repair for recurrent inguinal hernia. Methods Clinical data of 130 cases of recurrent inguinal hernia who underwent TAPP hernia repair from Mar. 2009 to Dec. 2012 in Beijing Chao-Yang Hospital of Capital Medical University were retrospectively analyzed. Results Operations were completed successfully in 129 cases and 1 case was converted to open surgery. The operation time was （54.5±16.1） min （30-100min） and the hospital stay was （4.5±2.1） d （2-11d）. The rates of postoperative pain， hydrocele， and urinary retention were 3.8% （5/130），11.5% （15/130）， and1.5% （2/130） respectively. There were no complications such as foreign body sensation，wound infection，and intestinal obstruction after operation. All cases were followed-up for 7-50 months 〔（24.3±11.3） months）〕 with no recurrence was observed. Conclusions Laparoscopic TAPP hernia repair for recurrent inguinal hernia has advantages of minimal invasion and few complications，who is safe and effective.