Multifactor study of efficacy and recurrence in laparoscopic surgery for inguinal hernia

BACKGROUND Inguinal hernia is a common clinical manifestation in children with a low selfhealing rate.AIM To determine the effect of laparoscopic surgery on indirect inguinal hernia and the risk factors for postoperative recurrence and to provide a reference for the clinical treatment and prevention of recurrence.METHODS We selected 360 children who underwent laparoscopic high ligation in our hospital as the laparoscopic group and 120 patients treated for inguinal hernia with conventional surgery as the control group.The operation time,blood loss,incision length,hospitalization time,total hospitalization cost and surgical complications were compared between the two groups.According to telephone follow-up or return visits,the children who had recurrence within 2 years after the operation in the laparoscopic group were analyzed,and the laparoscopic high ligation hernia sac level was analyzed by the logistic multifactor method.Ligation was used to treat recurrence in children with inguinal hernia.RESULTS The operation time,blood loss,length of incision,and length of hospital stay in the laparoscopic group were lower than those in the control group(P<0.05).The total hospitalization cost in the laparoscopic group was higher than that in the control group(P<0.05).The operative complication rate was 1.67%lower than that in the control group(12.50%)(P<0.05).In 360 children with laparoscopic high ligation of the hernia sac,14 patients had recurrence within 2 years after surgery.After analysis,14 cases in the recurrence group did not recur.The preoperative incarceration rate,inner ring diameter,ligature use and age difference were statistically significant(P<0.05).According to logistic regression multivariate analysis,an inner ring diameter≥1.0 cm,the use of an absorbable ligature line and age>3 years increased the risk of postoperative recurrence in children with inguinal hernia after laparoscopic high ligation of the hernia sac(P<0.05).CONCLUSION Laparoscopic surgery for indirect inguinal hernia in children has the advantages of low trauma and a rapid postoperative recovery.An inner ring diameter≥1.0 cm,the use of absorbable ligature,and age>3 years may increase the risk of recurrence after laparoscopic high ligation of the hernia sac.

TLR4 Knockout Attenuates BDL-induced Liver Cholestatic Injury through Amino Acid and Choline Metabolic Pathways

The exact mechanism by which knockout of Toll-like receptor 4(TLR4)attenuates the liver injury remains unclear.The present study aimed to examine the role of TLR4 in the pathogenesis of bile duct ligation(BDL)-induced liver cholestatic injury and the underlying mechanism.Wild type(WT)mice and TLR4 knockout(TLR4-KO)mice were used for the establishment of the BDL model.Metabolomics were applied to analyze the changes of small molecular metabolites in the serum and liver of the two groups.The serum biochemical indexes and the HE staining results of liver tissue showed that liver damage was significantly reduced in TLR4-KO mice after BDL when compared with that in WT mice.The metabolite analysis results showed that TLR4 KO could maintain the metabolisms of amino acids-and choline-related metabolites.After BDL,the amino acids-and choline-related metabolites,especially choline and 3-hydroxybutyrate,were significantly increased in WT mice(both in serum and liver),but these metabolites in the liver of TLR4-KO mice after BLD were not significant different from those before BLD.In conclusion,TLR4 KO could attenuate BDL-induced liver cholestatic injury through regulating amino acid and choline metabolic pathways.