Inguinodynia following Lichtenstein tension-free hernia repair:A review

Chronic Groin Pain (Inguinodynia) following inguinal hernia repair is a significant,though under-reported problem. Mild pain lasting for a few days is common following mesh inguinal hernia repair. However,moderate to severe pain persisting more than 3 mo after inguinal herniorrhaphy should be considered as pathological. The major reasons for chronic groin pain have been identified as neuropathic cause due to inguinal nerve(s) damage or non-neuropathic cause due to mesh or other related factors. The symptom complex of chronic groin pain varies from a dull ache to sharp shooting pain along the distribution of inguinal nerves. Thorough history and meticulous clinical examination should be performed to identify the exact cause of chronic groin pain,as there is no single test to confirm the aetiology behind the pain or to point out the exact nerve involved. Various studies have been performed to look at the difference in chronic groin pain rates with the use of mesh vs non-mesh repair,use of heavyweight vs lightweight mesh and mesh fixation with sutures vs glue. Though there is no convincing evidence favouring one over the other,lightweight meshes are generally preferred because of their lesser foreign body reaction and better tolerance by the patients. Identification of all three nerves has been shown to be an important factor in reducing chronic groin pain,though there are no well conducted randomised studies to recommend the benefits of nerve excision vs preservation. Both nonsurgical and surgical options have been tried for chronic groin pain,with their consequent risks of analgesic sideeffects,recurrent pain,recurrent hernia and significant sensory loss. By far the best treatment for chronic groin pain is to avoid bestowing this on the patient by careful intra-operative handling of inguinal structures and better patient counselling pre-and post-herniorraphy.

Comparative Analysis of the Efficacy of Transabdominal Pre-Peritoneal Vs Open Tension-Free Hernia Repair in Treating Inguinal Hernia

Objective:To investigate and analyze the clinical outcomes of inguinal hernia patients treated with transabdominal pre-peritoneal repair(TAPP)versus open tension-free hernia repair.Methods:The study was carried out from January 2021 to August 2023,and a total of 50 inguinal hernia patients were selected for this study.The patients were randomly divided into a study group(n=25)and a control group(n=25)by the numerical table method.The patients in the control group were treated with open tension-free hernia repair,whereas the patients in the study group were treated with TAPP.The surgical and postoperative recovery indexes,complication rates,and recurrence rates of the two groups were compared.Results:There was no significant difference in the operative time and intraoperative blood loss between the two groups(P>0.05),and the postoperative feeding time,time out of bed,and hospitalization time of the study group were shorter than those of the control group(P<0.05);the incidence rate of postoperative complications in the study group was lower than that in the control group(P<0.05);and there was no significant difference in the recurrence rate of the two groups after operation(P>0.05).Conclusion:Compared to open tension-free hernia repair,TAPP offers a shorter postoperative recovery duration and hospitalization time,and reduces the incidence of complications.Therefore,this surgical method should be popularized in the treatment of inguinal hernia.

Analysis of the Effect and Efficiency of Tension- Free Hernia Repair and Traditional Surgery in The Treatment of Hernia

Objective: To analyze the efficiency of tension-free hernia repair and traditional surgery in the treatment of hernia. Methods: A total of 80 patients with hernias were selected and randomly into a control group (traditional hernia repair) and an observation group (tension-free hernia repair), of 40 cases each. The perioperative indicators, pain, physiological stress indicators, complications, and recurrence rates between the two groups were compared. Results: The perioperative indexes of the observation group were better than those of the control group (P < 0.05). The postoperative pain score, postoperative physiological stress index level, incidence of complications, and recurrence rate of the observation group were lower than those of the control group (P < 0.05). Conclusion: In the surgical treatment of hernia, tension-free hernia repair was less traumatic and had a better effect than traditional hernia repair.

Analysis of Ultrasound-guided Ilioinguinal and Iliohypogastric Nerve Block in Tension-Free Inguinal Hernia Repair in Elderly Patients

Objective:To explore the value of ultrasound-guided ilioinguinal and iliohypogastric nerve block(IINB)in tension-free inguinal hernia repair in elderly patients.Methods:A total of 70 elderly patients with tension-free inguinal hernia repair who treated in the hospital from April 2018 to November 2019 were selected and divided into two groups according to the random number table method,with 35 cases each.The control group underwent infiltration of local anesthesia(LA),and the study group added with IINB.The visual analogue scale(VAS)scores of the two groups of patients were compared.Results:The VAS score of the study group when pulling the hernia sac was lower than that of the control group,and the difference was statistically significant(P<0.05).Conclusion:IINB has good analgesic effect in tensionfree inguinal hernia repair in elderly patients,and it is worth promoting.

TAPP与Lichtenstein无张力疝修补术治疗青年腹股沟疝的短期效果比较

目的比较青年腹股沟疝患者应用腹腔镜经腹腹膜前疝修补术(Transabdominal Preperitoneal Prosthesis,TAPP)以及李金斯坦(Lichtenstein)无张力疝修补术后的短期效果。方法选取南京市高淳人民医院于2019年12月—2022年12月收治的78例青年腹股沟疝患者作为研究对象,采用随机数表法分成两组,即对照组(39例)、观察组(39例)。对照组采取Lichtenstein术,观察组采取TAPP。对比两组临床各项指标、炎性因子水平、疼痛状态、总有效率、短期效果。结果观察组的术中出血量较少,肛门排气时间、下床活动时间和住院时间较短,肿瘤坏死因子、白介素-6、C反应蛋白水平更低,视觉模拟疼痛评分更低,差异有统计学意义(P均<0.05)。观察组治疗总有效率较高,差异有统计学意义(P<0.05)。对照组并发症发生率、复发率为17.95%、11.76%,与观察组(7.69%、4.76%)比较,差异无统计学意义(χ^(2)=1.835、0.634,P均>0.05)。结论针对青年腹股沟疝患者采取TAPP与Lichtenstein术的短期疗效相当,但TAPP能够有效缓解炎症,疼痛感低,更有利于患者恢复。

TAPP与Lichtenstein修补术在腹股沟疝患者中的应用效果对比

目的比较经腹腔腹膜前疝修补术(TAPP)与Lichtenstein修补术对腹股沟疝患者的影响。方法选取2021年1月—2023年11月新疆四七四医院收治的100例腹股沟疝患者为研究对象,按随机数字表法将其分为对照组和观察组,各50例。对照组行Lichtenstein修补术治疗,观察组行TAPP治疗。对比两组手术相关指标、术后疼痛程度、应激反应、并发症发生情况。结果观察组术中出血量为(14.25±2.18)mL,少于对照组的(20.31±2.69)mL,手术时间为(48.72±3.59)min、住院时间为(4.30±0.56)d,均短于对照组的(70.69±5.31)min、(6.31±1.42)d,并发症发生率4.00%低于对照组的16.00%,组间差异有统计学意义(P<0.05)。术后1、3 d,观察组疼痛视觉模拟评分分别为(2.38±0.41)分、(1.56±0.22)分,均低于对照组的(3.21±0.59)分、(2.29±0.34)分,组间差异有统计学意义(P<0.05)。术后1 d,观察组皮质醇水平(176.38±16.52)nmol/L、去甲肾上腺素水平(296.45±29.12)pmol/L均低于对照组的(198.92±20.31)nmol/L、(318.77±32.45)pmol/L,组间差异有统计学意义(P<0.05)。结论相较于Lichtenstein修补术,TAPP创伤更小、并发症更少,引起的应激反应更轻,可有效减轻腹股沟疝患者术后疼痛程度,有一定的应用价值,值得临床借鉴。

Current trends in laparoscopic groin hernia repair: A review

Hernia is a common problem of the modern world with its incidence more in developing countries. Inguinal hernia is the most common groin hernia repaired worldwide. With advancement in technology operative techniques of repair have also evolved. A Pub Med and COCHRANE database search was accomplished in this regard to establish the current status of laparoscopic inguinal hernia repair in view of recent published literature. Published literature support that laparoscopic hernia repair is best suited for recurrent and bilateral inguinal hernia although it may be offered for primary inguinal hernia if expertise is available.

腹膜前间隙修补术对比Lichtenstein修补术治疗老年单侧腹股沟疝的临床效果

目的:探讨腹膜前间隙修补术对比李金斯坦无张力疝修补术(Lichtenstein术)治疗老年单侧腹股沟疝的临床效果。方法:选取2020年1月至2021年6月于我院普外科就诊的180例腹股沟疝患者作为研究对象,按照手术术式不同分为对照组和实验组,各90例。对照组采用Lichtenstein修补术,实验组采用腹膜前间隙修补术。比较两组身体恢复情况相关指标、并发症、术后视觉模拟量表(Visual analogue scale,VAS)评分以及复发率。结果:实验组手术时间、住院时间、下床活动时间均明显短于对照组,术中出血量明显低于对照组(P<0.05);实验组并发症发生率、术后24 h的VAS评分均明显低于对照组(P<0.05);两组术后30d和60d的VAS评分、术后复发率均无明显差异(P>0.05)。结论:对老年单侧腹股沟疝患者来说,推荐开放式腹膜前间隙修补术进行临床治疗,相比Lichtenstein修补术的安全性更高,患者疼痛感更轻,预后更好。

Analysis of the Causes of Chronic Pain after Inguinal Hernia Repair without Tension and Its Prevention and Treatment

Purpose: Analyzing the causes of pain after tension-free repair in the inguinal hernia, and propose corresponding treatment strategies. Results: The patients in this group were followed up for 3 - 12 months. A total of 5 patients still had pain relief within 3 months after surgery. Further treatment was needed, and the incidence rate was 5%. Conclusion: Skilled surgical procedures are performed in patients with local anesthesia, and some of the absorbable repair materials can be used. The improved patch fixation and extra peritoneal repair can reduce the pain after inguinal hernia repair without tension.

Cost effective use of mosquito net mesh in inguinal hernia repair

Mesh hernia repair is one of the commonest open techniques of inguinal hernia repair.The main limiting factor in the use of new meshes is the cost.We carried out a prospective randomized double blind study and comprising of a hundred patients with 100 inguinal hernias admitted consecutively for elective surgery,divided into the polypropylene mesh(PPM)group and the mosquito net mesh(MNM)group each containing fifty patients.All cases were completed successfully and results revealed no difference in two groups.The results of the present study,in consistent with the published literature,reveal that the cheap indigenous mosquito mesh,which has similar properties of an imported mesh,can be safely used for tension-free inguinal hernia repair in adults.Further trials with a larger number of patients and longer follow-ups are justified and recommended.

TAPP与Lichtenstein无张力疝修补术在女性腹股沟疝治疗中的应用效果

目的:探讨腹腔镜经腹腹膜前腹股沟疝修补术(TAPP)与李金斯坦(Lichtenstein)无张力疝修补术在女性腹股沟疝中的应用效果。方法:选取2015年9月—2022年9月福建医科大学附属龙岩市第一医院收治的100例女性腹股沟疝患者为研究对象,按随机数表法将其分为两组,各50例。对照组行Lichtenstein无张力疝修补术治疗,观察组行TAPP治疗。比较两组手术情况、疼痛评分、应激反应水平、炎症水平、生活质量及并发症。结果:观察组手术时间较对照组长,肛门排气时间、下床活动时间较对照组早,住院时间较对照组短,术中出血量较对照组少,差异有统计学意义(P<0.05)。术后6 h、24 h、48 h,观察组疼痛评分较对照组低,差异有统计学意义(P<0.05)。术后24 h,两组醛固酮(ALD)、皮质醇(Cor)、去甲肾上腺素(NE)水平较术前高,但观察组ALD、Cor、NE水平较对照组低,差异有统计学意义(P<0.05)。术后24 h,两组C反应蛋白(CRP)、白介素-6(IL-6)及肿瘤坏死因子-α(TNF-α)水平较术前高,但观察组CRP、IL-6、TNF-α水平较对照组低,差异有统计学意义(P<0.05)。术后3个月,两组生活质量各领域评分较术前高,且观察组生活质量各领域评分较对照组高,差异有统计学意义(P<0.05)。观察组并发症发生率低于对照组,差异有统计学意义(P<0.05)。结论:TAPP治疗女性腹股沟疝效果更佳,可减轻机体创伤,降低应激反应及炎症水平,缩短住院时间,且术后疼痛评分低、并发症少,有助于改善生活质量。

改良Kugel修补术与Lichtenstein修补术治疗腹股沟疝的研究分析

目的 对改良Kugel修补术与Lichtenstein修补术治疗腹股沟疝的效果进行对比分析。方法 选取2022年1-12月邳州市人民医院普外科收治的96例腹股沟疝患者,随机分为观察组、对照组,每组48例,分别给予改良Kugel修补术和Lichtenstein修补术治疗,比较两组的治疗效果。结果 观察组的手术用时、术中出血量、术后首次下床时间均较对照组显著更低(P<0.05)。两组术后1d和术后120d的VAS评分差异不显著(P>0.05),观察组术后30d和术后60d的VAS评分均显著低于对照组(P<0.05)。观察组并发症发生率显著低于对照组(P<0.05)。结论 和Lichtenstein修补术相比,改良Kugel修补术对腹股沟疝患者手术指标的改善效果较好,痛感改善效果更明显,并发症少,复发率低,疗效显著,值得推广。

完全腹膜外疝修补术与Lichtenstein修补术治疗成人腹股沟疝随机对照试验的Meta分析

目的:对比分析完全腹膜外疝修补术(totally extraperitoneal prosthetic,TEP)与Lichtenstein修补术治疗成人腹股沟疝临床疗效和安全.方法:计算机检索中国知识资源总库、中国生物医学文献数据库、万方数据库、维普网、西文生物医学期刊文献数据库、Pub Med、Cochrane图书馆等数据库,查找自建库以来至2014-05国内外关于TEP与Lichtenstein修补术临床疗效分析的随机对照研究(randomized controlled trials,RCT).按照纳入与排除标准选择文献、提取资料、评价质量后,采用Rev Man5.1软件进行Meta分析.结果:共纳入1 2项前瞻性随机对照研究,3249例患者,其中TEP修补术1591例Lichtenstein修补术1658例.Meta分析结果显示:(1)手术时间:10项研究(n=2642)的手术时间差异具有统计学意义(MD=6.2395%C I:2.07-10.38,P=0.003);(2)术后并发症:9项研究(n=2740)术后并发症的发生率差异具有显著统计学意义(OR=0.5695%CI:0.46-0.69,P<0.0001);(3)住院时间:6个研究(n=348)住院时间差异无统计学意义(MD=-0.84,95%CI:-1.81-0.13,P=0.09)(4)恢复正常活动时间:7项研究(n=2329)两组间差异具有显著统计学意义(MD=-4.2795%CI:-5.58--2.96,P<0.0001).结论:与Lichtenstein修补术相比,TEP能显著减少成人腹股沟疝修补术后并发症和恢复正常活动时间,其手术时间却较长,但仍需要更多长期的、高质量、大样本、多中心的研究加以验证.

TEP与Lichtenstein在疝修补术中的临床对比研究

目的:对TEP与Lichtenstein在疝修补术中的临床应用进行对比研究。方法:选取西安市中心医院普一科自2013年3月至2015年2月收治的106例采用TEP手术的患者和同时期104例采用Lichtenstein手术的腹股沟疝患者资料作为研究对象,回顾分析两组患者的手术时间、术后早期疼痛评分、术中出血量、术后下床时间、平均住院时间、住院费用和术后并发症发生率等指标。结果:两组患者手术顺利,无严重术中及术后并发症发生。TEP操作组在术中出血量、术后下床时间、平均住院时间方面均短于Lichtenstein组,差异具有统计学意义(P<0.05),手术费用高于Lichtenstein组(P<0.05),两组在手术时间方面相比差异无统计学意义(P>0.05)。回顾分析两组患者术后5d及出院随访6个月的资料,TEP组在术后异物感、尿储留、阴囊血清肿、术后早期疼痛评分、术后长期慢性神经疼痛发生率方面均低于Lichtenstein组(P<0.05)。两组在皮下血肿及术后复发率方面差异均无统计学意义(P>0.05)。结论:TEP手术具有微创、术后患者病情恢复快、痛苦小、并发症少的优点,值得推广应用。

Lichtenstein术在治疗腹股沟疝中的优势

目的总结Lichtenstein术式在治疗腹股沟疝中的临床效果和优势。方法选取沭阳县中医院普通外科2011年01月至2013年12月外科收治的确诊为腹股沟疝患者118例,按数字法随机分为对照组与观察组,两组均59例。给予对照组传统的疝修补术进行治疗,对观察组采用Lichtenstein术式进行疝修补,比较两组患者的手术时间、住院时间、术后下床活动时间及术后尿潴留、切口血肿血清肿、阴囊积液水肿、血肿等并发症发生情况。结果通过比较分析,观察组手术所用时间、住院时间、术后下床活动时间、术后尿潴留、切口血肿血清肿、阴囊积液水肿、血肿等并发症发生情况观察组要低于对照组,差异有统计学意义(P<0.01)。结论采用Lichtenstein术式治疗腹股沟疝相对传统疝修补术具有临床应用优势。

腹腔镜腹股沟疝修补术与Lichtenstein无张力疝修补术的前瞻性随机对照研究

目的探讨腹腔镜腹股沟疝修补术和Lichtenstein无张力疝修补术的安全性、可行性及各自优缺点。方法采用前瞻性随机对照研究将2005年3月～2010年3月252例成人腹股沟疝采用信封法随机分成TAPP组(n=84)、TEP组(n=84)及Lichtenstein组(n=84),比较3组手术时间、术后疼痛评分、术后阴囊血清肿或积液、术后局部皮肤感觉障碍、术后慢性疼痛、术后远期疝复发及住院费用等。结果 168例腹腔镜手术均顺利完成,无中转开放手术。TAPP组和TEP组术后疼痛评分明显低于Lichtenstein组[(2.94±0.99)分vs.(4.25±0.46)分,q=16.434,P<0.05;(1.98±0.64)分vs.(4.25±0.46)分,q=28.477,P<0.05],住院费用明显高于Lichtenstein组[(9504±1132)元vs.(5852±864)元,q=33.481,P<0.05;(9351±985)元vs.(5852±864)元,q=32.079,P<0.05]。TAPP组和TEP组术后均无复发,显著低于Lichtenstein组4.8%(4/84)(P=0.012)。3组手术时间、术后阴囊血清肿或积液、术后局部皮肤感觉障碍、术后慢性疼痛无明显差异(P>0.05)。结论腹腔镜疝修补术,无论是TAPP还是TEP都是安全可行的,在术后疼痛评分、术后复发方面方面要明显优于Lichtenstein术式,但腹腔镜疝修补术手术费用较高。

应用聚丙烯轻量型平片行Lichtenstein手术在老年快速康复疝外科实践中的临床研究

目的探讨应用聚丙烯轻量型平片行Lichtenstein手术在老年快速康复疝外科实践中的优越性及可行性。方法选取2015年1月~2019年1月中国医科大学人民医院暨辽宁省人民医院普外一科收治的120例老年腹股沟疝患者作为研究对象,根据应用补片和手术方式的不同分为研究组(n=67)和对照组(n=53)。研究组患者采用聚丙烯轻量型平片进行Lichtenstein手术,对照组患者采用PHS补片行开放式腹膜前间隙无张力疝修补术。分析比较两组患者的手术相关指标、术后疼痛评分、术后并发症发生情况、术后1个月生活质量评分和总满意度、随访1年复发情况。结果研究组患者的手术时间、离床活动时间、住院日均短于对照组,术后中度以上疼痛、异物感发生率低于对照组,差异有统计学意义(P<0.05)。术后第1、3、5、7天,研究组患者的疼痛评分低于对照组,差异有统计学意义(P<0.05)。术后1个月,研究组患者的生活质量评分及总满意度均高于对照组,差异有统计学意义(P<0.05)。两组患者均无切口感染、尿潴留、血清肿等并发症发生,随访1年无复发。结论应用聚丙烯轻量型平片行Lichtenstein手术操作简单、并发症少,术后康复质量高,在老年快速康复疝外科实践中具有明显的临床优越性。

开放式前入路腹膜前疝修补术与Lichtenstein疝修补术的对照研究

目的通过对开放式前入路腹膜前疝修补术与Lichtenstein疝修补术2种术式的疗效比较,总结2种手术方法优缺点。方法将134例腹股沟疝患者按随机数字表法分为2组:开放式前入路腹膜前疝修补术组71例、Li-chtenstein疝修补术组63例,对2组疗效进行对比分析。结果开放式前入路腹膜前疝修补术组在术后疼痛、术后异物感、术后复发方面优于Lichtenstein疝修补术组(均P<0.05)。结论开放式前入路腹膜前疝修补术是目前较理想的疝修补术,能减少术后不适与复发。

Lichtenstein、Rutkow与Kugel腹股沟疝修补术215例临床疗效比较研究

目的 :探讨平片(Lichtenstein)无张力腹股沟疝修补术、疝环充填式(Rutkow)腹股沟疝修补术和腹膜前(Kugel)腹股沟疝修补术的临床疗效差异。方法 :选取我院腹股沟疝患者215例,根据不同的手术方式将患者分为A组(72例,采用Lichtenstein修补术),B组(72例,采用Rutkow修补术)和C组(71例,采用Kugel修补术)。比较3组间患者临床疗效的差异。结果:A组手术时间最短,其次为B组,C组最长,3组间比较差异具有统计学意义(P<0.05),C组下床时间明显长于A、B组(P<0.05),C组住院时间明显长于A组(P<0.05)。术后30 d、180 d,A、C组VAS评分均明显低于B组(P<0.05)。3组尿潴留、切口感染、阴囊水肿发生率与复发率比较差异无统计学意义(P>0.05),A组与C组异物感率明显低于B组(P<0.05)。结论 :Lichtenstein术后恢复时间短,有助于改善术后疼痛与异物感;Rutkow术后疼痛与异物感较为严重,而Kugel腹股沟疝修补术明显改善术后恢复时间、术后疼痛与异物感程度。

腹腔镜微创术式与Lichtenstein修补术治疗老年复发性腹股沟疝的临床对比观察

目的比较腹腔镜微创术式与Lichtenstein修补术治疗老年复发性腹股沟疝的临床疗效,为临床选择适合的治疗方法提供依据。方法选择29例老年复发性腹股沟疝患者,采用腹腔镜微创术式治疗(研究组);另外选择29例患者采用Lichtenstein修补术治疗(对照组),比较两组治疗的平均手术时间、术后视觉模拟疼痛评分与住院时间等。结果研究组患者根据前次手术的方式,分为三种不同微创术式治疗,分别为经腹腹膜前腹腔镜腹股沟疝修补术(TAPP)20例,腹腔镜全腹膜外疝修补术(TEP)4例,腹腔镜腹腔内补片植入术(IPOM)5例;研究组患者手术均能顺利完成,无中转开腹的患者。平均手术时间(43.32±12.83)min,术中出血量(53.3±10.3)ml,术后第1天平均视觉模拟疼痛评分(VAS)为(2.34±1.21)分,术后平均住院时间(2.1±1.1)天,均显著低于对照组(P<0.05)。结论腹腔镜治疗老年复发性腹股沟疝具有更好的治疗效果,其中TAPP术式是目前使用最为广泛的腹腔镜复发性腹股沟疝的修补方法,值得临床运用。