Objective To retrospectively compare short-term outcomes and health economics of PHS versus UHS for inguinal hernia repair. Methods We included 105 patients suffering from reducible inguinal hernia hospitalized in the First Affiliated Hospital of Lanzhou University from September, 2007 and September, 2012. The referred hernia types involved direct and indirect hernia (unilateral and bilateral). Based on different repair materials, the patients were divided into two groups, PHS group (n=53) and UHS group (n=52). Outcome parameters for comparison included incidences of seroma and scrotum edema, hospital duration, costs, etc. Results There were no differences in age, sex, hernia type, incidences of seroma and scrotum edema after surgery, hospital duration and costs between the two groups. However, the patients in the PHS group spent less money than those in the UHS group regarding the costs of materials and hospitalization, with significant differences. Conclusion For inguinal hernia repair, PHS and UHS are alike in reducing short-term complications, but PHS can significantly reduce patients’ economic burden due to less costs.
Objective To discuss the surgical treatment and experience of mesh infection after prosthetic patch repair of inguinal hernia. Methods The clinical data of 67 cases of mesh infection after prosthetic patch repair who were treated in Chao-Yang Hospital from Jan. 2011 to Jun. 2012 were retrospectively analyzed. Results All patients were treated with surgical operation successfully， including removing the infected mesh and surrounding tissues， primary suture， and a placement of wound drainage， without replacement of a new patch substitute. The hospital stay of the patients was 10-25days with an average of 16days. Of the 67 patients， 51 patients got primary healed and the other 16 patients healed delayed after local dressing change due to the superficial infection following stitch removal. Sixty-six patients were followed-up for 6-24 months （average of 20 months） after operation without recurrence and complication， including seroma， wound infection， intestinal fistula， and postoperative pain. Conclusions The treatment of mesh infection after inguinal hernia repair is very complicated， but the primary suture repair and a placement of wound drainage after removing infected mesh with complete debridement is a effective therapy for it.
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.
Objective To assess the significance of multi-detector row CT in differential diagnosis of the inguinal hernia and femoral hernia. Methods CT images which were reconstructed by multi-planer reconstruction （MPR） of 260 patients with inguinal hernia and femoral hernia who treated in our hospital form Oct. 1， 2012 to Oct. 31， 2013 were analyzed retrospectively， for exploring the relationship between sac and anatomic structure in the groin area. Results There were 146 patients with indirect hernia （75 in right， 60 in left， and 11 in bilateralism）， 82 patients with direct hernia（39 in right， 34 in left， and 9 in bilateralism）， and 32 patients with femoral hernia （17 in right and 15 in left）. The 157sacs of patients with indirect hernia originated lateral to the inferior epigastric artery， entered the inguinal canal and through the deep ring， which mainly located anterior （103/157， 65.6%） or anteromedial （36/157， 22.9%） to the spermatic cord or round ligament. The 91 sacs of patients with direct hernia originated medial to the inferior epigastric artery， and mainly located medial to the spermatic cord （70/91， 76.9%）. Sacs of both indirect hernia and direct hernia located anterosuperior to the inguinal ligament. The 32 sacs of patients with femoral hernia located posterior to the inguinal ligament and inside the “radiological femoral triangle” of coronal views. Conclusions The MPR images available from multi-detector row CT permit the accurate diagnosis of groin hernias. By using simple anatomical criteria， direct hernia， indirect hernia， and femoral hernia can be reliably distinguished．
Objective To compare the feasibility， safety， and efficiency of laparoscopic total extraperitoneal （TEP）hernia repair surgery and laparoscopic transabdominal preperitoneal （TAPP） hernia repair surgery. Methods The clinical data of 95 patients with inguinal hernia who underwent laparoscopic TEP hernia repair surgery （TEP group） and TAPP hernia repair surgery （TAPP group） from Mar. 2010 to Oct. 2013 in our hospital were retrospectively analyzed， and clinical parameters including operation time， intraoperative blood loss， postoperative hospital stay， postoperative comp-lication， and operation cost of 2 groups were compared. Results All the procedures were successful， none of them was converted to open surgery. There was no significant difference between TEP group and TAPP group when considering operation time 〔（65±16） min vs.（68±17） min〕， intraoperative blood loss 〔（7.0±1.2） mL vs. （8.0±1.4） mL〕， visual pain analogue scale 〔（2.0±1.1） score vs. （1.8±1.1） score〕， postoperative hospital stay 〔（3.1±1.4） d vs. （3.3±1.2） d〕，and time to release to regular activities 〔（4.2±1.0） d vs. （4.5±1.2） d〕， P＞0.05. But the operation cost of TEP group was significantly lower than that of TAPP group 〔（8 033±536） yuan vs. （9 632±643） yuan， P=0.007〕. There were 6 atients （6.3%， 6/95） suffered complications， 3 cases in TEP group and 3 cases in TAPP group， including 3 cases of seroma or hematoma in scrotum， 1 case of transient neurapraxia， and 3 cases of urinary retention. There was no signi-ficant difference in incidence rate of postoperative complication between the 2 groups （P=1.000）. All patients were followed-up for 1-35 months 〔（20.0±10.2） months〕 without recurrence and chronic pain. Conclusions TEP and TAPP hernia repair surgery are feasible， safe， effective， and minimally invasive technique for inguinal hernioplasty. There are advantages and disadvantages of both TAPP and TEP hernia repair surgery， but there is no statistically significant difference regarding intraoperative and postoperative complications.
Objective To investigate the value of laparoscopy in resetting and repairing of inguinal incarcerated hernia. Methods Clinical data of 11 patients with acute inguinal incarcerated hernia treated with laparoscopy from March 2007 to February 2008 were reviewed, including 3 cases of direct inguinal hernia and 8 cases of oblique inguinal hernia. Results There were 7 patients with incarcerated hernia who were reset automatically after general anaesthesia, and 4 patients who were reset with laparoscopy. All the hernias were repaired with the transabdominal preperitoneal (TAPP) method after observed or improved the blood cycle of the incarcerated intestinal tract under laparoscopy. Average follow-up time was 6.6 months (2-12 months) after operation. Good recover and no recurrence were showed in all patients. Conclusion Laparoscopy is a safe technology in resetting and repairing of inguinal incarcerated hernia
ObjectiveTo retrospectively analyze the risk factors of recurrent groin hernia. MethodsData came from all hernia repairs recorded in our hospital between 1991 and 2001. A total of 1 082 cases of groin hernia was analyzed through Cox proportional hazard model to determine the relative risks between recurrence and mode of admission, types of groin hernia, repair methods (traditional/tensionfree hernioplasty), and postoperative complications.ResultsFrom 1991 to 2001,1 082 groin hernia operations were performed in our hospital, 88.9% for primary hernia and 11.2% for recurrent hernia. As compared with traditional hernia repair methods, Lichtenstein’s tensionfree hernioplasty technique had less relative risk for recurrent hernia repair than that for primary hernia repair. Postoperative complications and indirect hernia were linked to an increased relative risk for recurrence. ConclusionThere are many factors affecting the recurrence of inguinal hernia, but the use of tensionfree hernia repair may decrease rerecurrence of recurrent hernia.
Objective To explore the method and effectiveness of laparoscopic bundled fastigiated mesh in repairing inguinal hernia. Methods Between January 2003 and December 2009, 1 215 patients (1 363 sides) with inguinal hernia were treated. There were 1 132 males (1 268 sides) and 83 females (95 sides), aged from 18 to 89 years (median, 58 years). The cases included 1 187 cases (1 329 sides) of primary hernia and 28 cases (34 sides) of recurrent hernia. There were indirect inguinal hernia in 728 cases (786 sides), direct inguinal hernia in 416 cases (499 sides), femoral hernia in 43 cases (45 sides), and unusual hernia in 28 cases (33 sides). According to the hernia classification criteria, there were 31 cases (38 sides) in type I, 683 cases (754 sides) of type II, 403 cases (452 sides) of type III, and 98 cases (119 sides) of type IV. The disease duration was 1 to 9 days with an average of 3.8 days. To repair the hernia, the bundled fastigiated mesh was patched through the internal inguinal ring and fixed on the internal inguinal fascia by three-point fixation. The mesh would be wrapped in the peritoneum by purse-string suture. Results The surgeries were performd successfully. The operative time ranged from 18-32 minutes (mean, 22 minutes). Postoperative tractional pain in the inguinal region occurred in 19 cases (21 sides), acute uroschesis in 8 cases, and far-end hernial sac effusion in 2 cases (2 sides); all were cured after symptomatic treatment. All incisions healed by first intention, and no complications of fever, infection, or hematoma occurred. A total of 1 095 cases (1 182 sides) were followed up 1 to 7 years (median, 3 years and 9 months). Five patients died of medical illnesses at 1-3 years after operation. Three cases recurred and then were cured by a second surgery. No intestinal adhesion or obstruction occurred. Conclusion The bundled fastigiated mesh in laparoscopic inguinal hernia repair has the advantages of minimal invasiveness, easy-to-operate, less complications, and lower recurrence rate.
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.
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.