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 introduce a percutaneous transcalcaneal reconstruction technique for the treatment of acute Achilles tendon insertion avulsion, and to assess its short-term effectiveness. Methods Between January 2014 and June 2020, 25 patients with acute Achilles tendon insertion avulsion were treated with the percutaneous transcalcaneal reconstruction technique. There were 24 males and 1 female, with an average age of 44.1 years (range, 34-60 years). The disease duration was 1-5 days (mean, 1.8 days). There were 23 cases of sports injury and 2 cases of fall injury. The preoperative American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score was 55.6±6.7 and the visual analogue scale (VAS) score was 4.6±0.5. The operation time, intraoperative blood loss, hospital stay, related complications, the time of weight-bearing standing with a slightly raised heel, and the time of walking with a slightly raised heel were recorded. The AOFAS ankle-hindfoot score and the VAS score were used to evaluate the ankle joint function and the pain. Achilles tendon continuity was examined by color Doppler ultrasonography and healing of the Achilles tendon was examined by MRI. At last follow-up, the Arner-Lindholm scale was used to evaluate the effectiveness. Results The operation time was 45-50 minutes (mean, 46.8 minutes). The intraoperative blood loss was 10-20 mL (mean, 13.8 mL). The hospital stay was 4-6 days (mean, 4.9 days). The color Doppler ultrasonography before discharge showed the continuous recovery of the Achilles tendon. All incisions healed by first intention, and there was no complication such as sural nerve injury or deep venous thrombosis of lower extremity. All patients were followed up 15-50 months (mean, 30.3 months). After 14-21 days, the patients started to weight-bearing stand with a slightly raised heel, with an average of 17.6 days; they began to walk with a slightly raised heel at 20-28 days, with an average of 23.7 days. MRI showed that the Achilles tendon healed at last follow-up. The AOFAS score was 90.0±3.2 at 6 months after operation and 95.8±4.5 at last follow-up, and the VAS scores were 1.7±0.6 at 6 months and 1.0±0.8 at last follow-up, which were all improved when compared with those before operation (P<0.05); the difference was also significant between the two time points after operation (P<0.05). According to the Arner-Lindholm scale, the effectiveness at last follow-up was excellent in 25 cases. All patients had returned to sports. Conclusion The percutaneous transcalcaneal reconstruction technique is a promising alternative option in treating acute Achilles tendon insertion avulsion, for it can achieve early rehabilitation and better ankle function recovery.