腹壁巨大切口疝的修补是很困难的手术，在一些特殊的病例中，由于患者的全身情况严重恶化使得切口疝无法修补，如年老、病态性肥胖及呼吸功能严重紊乱的患者。近年来，随着生物材料在疝和腹壁外科的广泛应用，对巨大腹壁切口疝的治疗已取得了明显进展。
ObjectiveTo evaluate the application of portosystemic shunt after subcutaneous transposition of the spleen (STS) to orthotopic liver transplantation (OLT) in the rat. MethodsOne hundred and eighty Wistar rats were randomly divided into the group of orthotopic liver transplantation after portosystemic shunts by subcutaneous transposition of the spleen (STS+OLT group) and the group of orthotopic liver transplantation (OLT group). The two groups were further divided into A, B, C subgroups in the light of duration of anhepatic phase (phases were respectively less than 25 min, around 35 min and 45 min).There were fifteen rats in each subgroup. At the described intervals, blood samples were collected from the peripheral and portal vein for testing ALT, pH and endotoxin levels. The survival rates were also observed. Results The ALT value of all animals basically returned to normal levels on the 7th postoperative day in the STS+OLT group and the OLT A subgroup, but in OLT B subgroup, ALT was still remarkably elevated on the 7th postoperative day (P＜0.01), and returned to normal levels on the 30th postoperative day. The pH values and endotoxin levels from the portal vein of all animals in STS+OLT groups and OLT A subgroup had no significant difference (Pgt;0.05) at the beginning, the end of the anhepatic phase and at the time of reperfusion for 30 min. But in the OLT B and C groups, the pH values and endotoxin levels were significantly higher at the end of anhepatic phase and reperfusion for 30 min than those in the beginning of anhepatic phase (P＜0.01). The survival rates at postoperative different time points in both B and C subgroup of the OLT group were significantly lower than those in STS+OLT group animals (P＜0.05).Conclusion The portosystemic shunt by subcutaneous transposition of the spleen can notably improve both the success rate of the OLT procedure and the postoperative survival rate in the rat.
Objective To analyze the cl inical therapeutic effect of extended Sublay technique via previous incision for repairing flank hernias in comparison with routine Sublay technique. Methods Between May 2004 and May 2009, 41 patients with flank hernia were treated by extended Sublay repair via previous incision (extended Sublay repair group, n=18) and by routine Sublay repair (rountine Sublay repair group, n=23). In extended Sublay repair group, there were 11 males and 7 females with an average age of 45.2 years (range, 32-61 years); flank hernia was cuased by flank incision operation (12 patientswith surgery history of nephrectomy, adrenalectomy, and vascular procedure) and traffic accident (6 patients) with an average disease duration of 14.5 months (range, 8-23 months); and the locations were the left flank region in 11 patients (7 affected superior lumbar triangles and 4 affected inferior lumbar triangles) and the right flank region in 7 patients (5 affected superior lumbar triangles and 2 affected inferior lumbar triangles). In routine Sublay repair group, there were 14 males and 9 females with an average age of 48.7 years (range, 33-64 years); flank hernia was cuased by flank incision operation (15 patients with surgery history of nephrectomy, adrenalectomy, and vascular procedure), traffic accident (6 patients), and fall ing (2 patients) with an average disease duration of 18.2 months (range, 11-27 months); and the locations were the left flank region in 10 patients (5 affected superior lumbar triangles and 5 affected inferior lumbar triangles) and the right flank region in 13 patients (9 affected superior lumbar triangles and 4 affected inferior lumbar triangles). There was no significant difference in general data between 2 groups (P gt; 0.05). Results The mesh size in extended Sublay repair group was significantly larger than that in routine Sublay repair group [(618.2 ± 40.6) cm2 vs. (512.2 ± 36.5) cm2, P lt; 0.05 ]. There was no significant difference in hernia ring size, operation time, and hospital ization day between 2 groups (P gt; 0.05). In extended Sublay repair group, the patients were followed up 17 to 35 months (26.2 months on average) with an early compl ication incidence of 27.8% (hematomas in 2 cases, seroma in 1 case, and chronic pain in 2 cases within 1 month) and a late compl ication incidence of 0 (no hernia recurrence and abdominalwall bulge during follow-up). In routine Sublay repair group, the patients were followed up 14-35 months (24.5 months onaverage) with an early compl ication incidence of 13.0% (seroma in 1 case and chronic pains in 2 cases within 1 month) and a late compl ication incidence of 30.4% (hernia recurrence in 3 cases and abdominal wall bulge in 4 cases at 1-3 months). There was significant difference in the late compl ication incidence between 2 groups (P lt; 0.05). Conclusion Extended Sublay technique is a safe and effective approach for flank hernia repair. Making clear the anatomy of lumbar region, harvesting adequate space for mesh overlap, and effectively-fixing are critical to ideal cl inical outcomes.
ObjectiveTo investigate the clinical effects of laparoscopic hiatus reconstruction with Bard Crurosoft patch associated with Nissen fundoplication in elderly patients with gastroesophageal reflux disease (GERD). MethodsFrom July 2006 to July 2009, 22 consecutive elderly patients （≥65 years） with GERD underwent laparoscopic hiatus reconstruction associated with Nissen fundoplication， 10 of them underwent laparoscopic Crurosoft patch hiatus reconstruction (hiatus diameter≥5 cm in 2 patients， lt;5 cm in 8 patients) and 12 underwent laparoscopic simple sutured hiatus reconstruction (hiatus diameter≥5 cm in 2 patients， lt;5 cm in 10 patients). Intra and perioperative data including symptoms (heartburn, regurgitation, dysphagia, and respiratory complications), functional evaluations (esophagogastroscopy, manometric evaluations in lower esophageal segment, and 24 h pH-monitoring values) were compared and analyzed. ResultsPatients in 2 groups had similar preoperative values in demographics, symptom scores, functional evaluations, as well as operative data except for mean operative time. Three-month and 1-year follow-up after operation, the results of symptoms scores and functional evaluations of patients in 2 groups compared with preoperative values wear improved （Plt;0.05）, but symptoms scores and functional evaluations of patients in patch group were evaluated to demonstrate more significant improvement than suture group （Plt;0.05）. In suture group, the results of 3 months after operation were better than 1 year after operation, with statistically significant difference （Plt;0.05）. Two patients underwent postoperative intrathoracic immigration of wrap in suture group, but this complication did not happen in patch group （Plt;0.05）. ConclusionsLaparoscopic hiatus reconstruction with Bard Crurosoft patch associated with Nissen fundoplication is a safe and effective treatment for elderly patients(≥65 years) with GERD.
Objective To investigate and summarize preliminarily the clinical experiences of laparoscopic incisional hernia repair with intraperitoneal patch placement for the patients over 70 years old. Methods From July 2005 to July 2008, laparoscopic incisional hernia repair with intraperitoneal onlay meshes were applied in 8 patients, and whose clinical data were studied retrospectively. Results The procedures were performed successfully in all patients except one converted to open because of severe adhesion. The mean operative time was 105 min (ranged from 50 min to 180 min). One postoperative hypercapnia was resolved through mechanic ventilation for 24 h. One seroma and 1 prolonged postoperative pain over 1 month occurred, which were cured with conservative therapy. Mean postoperative hospital stay was 9.5 d (ranged from 7 d to 14 d). There was no recurrence or local discomfort during 12-36 months (average 26.5 months) follow-up.Conclusions Laparoscopic incisional hernia repair with intraperitoneal onlay mesh for the patients over 70 years old is safe and feasible, which has some advantages such as less trauma and rapid recovery. The perioperative management and operative technique are very important for the success of operation.
Objective To summarize the therapeutic experiences of abdominal wall bulge repair with compound patch intraperitoneal placement. Methods From October 2005 to October 2008, intraperitoneal onlay mesh with compound patch applied in 7 patients with abdominal wall bulge, whose clinical data were analyzed retrospectively. Results All the procedures were performed successfully, including 5 open operation and 2 laparoscopic repair. The mean operation time was 85 min (ranged 68 to 130 min). After operation, 1 seroma formation and 1 hemorrhage in the thoracic cavity developed and were cured with the conservative therapy. Mean postoperative hospital stay was 9.5 d (ranged 8 to 16 d). There was no recurrence, infection, or prolonged pain during 1－4 years follow-up. Conclusion Abdominal wall bulge is caused by the weakness of abdominal wall muscle, and the intraperitoneal onlay mesh repair with compound patch is an appropriate therapy.
Objective Surgical repair for giant lower ventral hernia is facing challenge owing to enormous tissue defect and the critical structures of pubis and il iac vessels. To investigate the method and curative effect of intraperitoneal onlay mesh (IPOM) combined with Sublay for compound repair of giant lower ventral hernia. Methods Between November 2008 and August 2010, 26 patients with giant lower ventral hernia were treated. There were 15 males and 11 females with an averageage of 61 years (range, 36-85 years), including 11 cases of lower midl ine incisional hernia due to radical rectal procedures, 6 cases of Pfannenstiel incisional hernia due to radical uterectomy, and 9 cases of lower midl ine incisional hernia due to radical cystectomy. Of them, 11 patients underwent previous repair procedures. The mean time from hernia to admission was 8.5 years (range, 1-15 years). All hernias were defined as M3-4-5W3 according to classification criteria of Europe Hernia Society. The mean longest diameter was 17.5 cm (range, 13-21 cm) preoperatively. Before 2 weeks of operation, abdominal binder was tightened gradually until the contents of hernia sac were reduced totally, and then reconstruction of abdominal wall was performed with compound repair of IPOM and Sublay technique. Results All of compound repair procedures were performed successfully. The mean hernia size was 112.5 cm2 (range, 76.2-160.6 cm2); the mean polypropylene mesh size was 120.4 cm2 (range, 75.3-170.5 cm2); and the mean compound mesh size was 220.0 cm2 (range, 130.4-305.3 cm2). The mean operative time was 155.5 minutes (range, 105.0-195.0 minutes) and the mean postoperative hospital ization time were 12 days (range, 7-16 days). Incisions healed by first intention; 4 seromas (15.4%) and 3 chronic pains (11.5%) occurred and were cured after symptomatic treatment. All patients were followed up 3-24 months (mean, 14.5 months). No recurrence and any other discomforts related to repair procedure occurred. Conclusion Compound repair of IPOM and Sublay is a safe and efficient surgical procedure for giant lower ventral hernia, owing to its characteristics of adequate patch overlap and low recurrence rate. Perioperative management and operative technology play the key role in the success of repair procedure.