ObjectiveTo investigate the effectiveness of repair procedure using biological mesh with Onlay-Reinforce technique in patients with perineal hernia. MethodsBetween January 2005 and December 2012, 9 patients with perineal hernia after laparoscopic abdominoperineal resection for rectal cancer (Miles operation) were treated. There were 3males and 6 females with a mean age of 70 years (range, 61-78 years). The disease duration was 1-9 months (mean, 4.5 months). The most beginning symptom was distending pain in perineal region, and then reducible mass was found without bowel incarceration. All patients underwent hernia repair using biological mesh with Onlay-Reinforce technique through original perineal incision. ResultsThe hernial size was 9.8-20.5 cm2 (mean, 16.0 cm2); the size of biological mesh was 58-80 cm2 (mean, 70.2 cm2); and the intraoperative blood loss was 10-80 mL (mean, 50.5 mL). All of the patients underwent repair operation successfully. The operation time was 45-90 minutes (mean, 60.6 minutes); and the hospitalization time was 4-7 days (mean, 5.9 days). One patient had urine retention, which was relieved after 7 days indwelling catheter. All the wounds healed by first intention without infection. The patients were followed up 14.5-60.7 months (mean, 37.8months). No chronic pain, obvious foreign body sensation, or hernia recurrence developed. ConclusionUse of biological mesh with Onlay-Reinforce technique for the repair of perineal hernia after Miles operation is safe and effective.
ObjectiveTo compare postoperatively clinical effect of endoscopic total thyroidectomy via breast approach versus traditional total thyroidectomy via neck in treatment of thyroid papillary carcinoma on postoperative function of parathyroid gland. MethodsRetrospective study performed on 124 thyroid papillary carcinoma patients who were hospitalized between June 2014 and December 2015 in Department of General Surgery of The First Affiliated Hospital of General Hospital of PLA. All patients underwent total thyroidectomy plus central Ⅵ lymphadenectomy. Endoscopic total thyroidectomy via breast were applied on 48 patients and traditional total thyroidectomy via neck were applied on 76 patients. Serum intact parathyroid hormone (iPTH) and calcium on postoperative day 1 were monitored for all patients. Then comparison of the serum iPTH and calcium between the 2 groups was performed. ResultsSerum iPTH and calcium for all 124 patients were within the normal range before surgery, and there was no significant difference between the endoscopic total thyroidectomy via breast group and traditional total thyroidectomy via neck group in the serum iPTH and calcium (P > 0.05). On 1 day after surgery, the level of iPTH in endoscopic total thyroidectomy via breast group was lower than that of traditional total thyroidectomy via neck group[(20.8±5.7) pg/mL vs. (28.3±4.9) pg/mL], and ratio of lower iPTH than normal of endoscopic total thyroidectomy via breast group was higher[43.8% (21/48) vs. 22.4% (17/76)], P < 0.05; but there was no significant difference in serum calcium between 2 groups[(2.1±0.3) mmol/L vs. (2.0±0.5) mmol/L], P > 0.05. In addition, the incidence of perioral, chiral and pedal numbness was higher in endoscopic total thyroidectomy via breast group than that of traditional total thyroidectomy via neck group[47.9% (23/48) vs. 27.6% (21/76)], P < 0.05. ConclusionsComparably, endoscopic total thyroidectomy via breast approach is more prone to lowly postoperative serum iPTH and calcium. Patients are more prone to exhibit clinical symptom such as perioral numbness, chiral and pedal numbness.
ObjectiveTo investigate the technique and early results of hybrid repair of parastomal hernia with the DynaMesh-IPST. MethodsA retrospective analysis was made on the clinical data of 28 patients who underwent DynaMesh-IPST hybrid repair of parastomal hernia between October 2013 and June 2016. There were 18 males and 10 females, aged 49-84 years (mean, 71 years). The disease duration of parastomal hernia was 6-60 months (mean, 27.6 months). The body mass index (BMI) was 17-35 (mean, 25.6); there were 15 obese patients (BMI > 26). ResultsThe operation was completed smoothly in all patients. The mean stoma diameter was 6 cm (range, 4-9 cm). The mean operation time was 142 minutes (range, 110-190 minutes). The mean hospital stay was 9 days (range, 7-12 days). Seroma was found in 2 patients, and was cured by needle aspiration and pressure bandage. All 28 cases were followed up 1-33 months (mean, 19 months). No recurrence, infection, intestinal fistula, and stoma-related problems were found. The appearance of abdominal wall was symmetrical. ConclusionDynaMesh-IPST hybrid repair is a safe and feasible method for parastomal hernia, and the short-term operative result is satisfactory.
ObjectiveTo explore the safety, effectiveness, and cosmetic advantage of endoscopic thyroidectomy for differentiated thyroid cancer in the cT1N0 stage. MethodsThe clinical data of 148 patients underwent thyroidectomy for the cT1N0 differentiated thyroid cancer in the First Affiliated Hospital of PLA General Hospital and the PLA General Hospital from September 2010 to September 2013 were analyzed retrospectively, including 36 patients by total endoscopic thyroidectomy (TET group), 41 patients by endoscopic-assisted thyroidectomy (EAT group), and 71 patients by open thyroidectomy (OT group). The intraoperative status, early complications, late complications, and cosmetic result were compared among these three groups. ResultsAll the procedures were accomplished successfully.①In the intraoperative status: The operation time of the TET group was significantly longer than that of the EAT group(P < 0.05)or OT group (P < 0.05), drainage on the first day after operation in the TET group was significantly more than that in the EAT(P < 0.05)or OT group (P < 0.05), the intraoperative bleeding of the TET group or EAT group was significantly less than that of the OT group (P < 0.05), there were no statistical significances in the total number of lymph nodes dissection and number of positive lymph nodes among three groups (P > 0.05).②In the early complications: The postoperative pain score of the TET group was significantly lower than that of the EAT group (P < 0.05)or OT group (P < 0.05), there were no statistical significances in the postoperative bleeding, seroma, infection, transient recurrent laryngeal nerve paralysis, or transient hypoparathyroidism among three groups (P > 0.05).③In the late complications: there was no statistical significance in the perpetual recurrent laryngeal nerve paralysis, perpetual hypoparathyroidism, or thyroid cancer relapse among three groups (P > 0.05).④The best cosmetic result was obtained by the patients underwent TET as compared with the patients underwent EAT(P < 0.05)or OT (P < 0.05). ConclusionsEndoscopic procedure has the same effectiveness and safety with open procedure for differentiated thyroid cancer in the cT1N0 stage, but endoscopic procedure has a better cosmetic result than that open procedure. Compared with EAT, TET has more advantages in the cosmetic result.