The Effect of Tension-Free Herniorrhaphy in the Preperitoneal Space on the Treatment of Hernia

Objective:To explore the clinical effect of tension-free herniorrhaphy in the preperitoneal space in patients with hernia.Methods:The study period was from January 2020 to December 2022.198 samples of hernia patients admitted to our hospital were selected and divided into a research group(n=99)and a control group(n=99).Patients in the control group underwent tension-free herniorrhaphy with plain films,and patients in the study group underwent tension-free herniorrhaphy in the preperitoneal space.The surgical and postoperative recovery-related indicators,incidence of complications,and recurrence rate were compared between the two groups.Results:The intraoperative and postoperative recovery indexes of the study group were better than those of the control group(P<0.05);the incidence of complications in the study group was lower than that of the control group(P<0.05),and there was no significant difference in the recurrence rate between the two groups(P>0.05).Conclusion:Tension-free herniorrhaphy in the preperitoneal space shortens the operation and postoperative recovery time of hernia patients and reduces the incidence of postoperative complications,so it should be popularized.

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.

Urethral complications after tension-free vaginal tape procedures:A surgical management case series

AIM： To analyze the clinical features, diagnostic modalities, and the surgical management of urethral complications after tension-free vaginal tape procedures.METHODS： This study encompasses a retrospective review of nine patients presented with urethral complic-ations after midurethral sling procedures. The patients underwent the procedures during a period from 1999 to 2012 in three different regional hospitals in the southwest part of Sweden. The time from sling placement to diagnosis, the risk factors, clinical features, diagnosis, surgical management, and functional outcome are presented. The presenting symptoms were described as either early onset （〈 12 mo） or late onset （〉 12 mo） according to when they were frst reported.RESulTS： Eight cases of urethral erosion and one case of bladder-neck erosion were detected. The mean interval for diagnoses of the erosions ranged from 3 mo to 11 years. The most common presenting symptoms included de novo urgency with or without incontinence （7/9 patients）, urinary retention/voiding dysfunction （4/9 patients）, urethritis （4/9 patients）, relapse of stress-incontinence （3/9 patients）, recurrent urinary tract infections （5/9 patients）, and hematuria （1/9 patient）. In most cases, voiding dysfunction and urethritis occurred early after the operation. The surgical management applied in most cases was transurethral resection of the intraurethral part of the mesh. The removal of the intraurethral mesh resulted in improvement or complete cure of urgency symptoms in 5/7 patients with urgency. Four patients were reoperated with a new stress-incontinence surgery, one with laparoscopic Burch, and three with retropubic tension-free vaginal tape procedures. COnCluSIOn： Urethral complications should be suspected in the case of de novo urgency and relapse of stress-incontinence. Transurethral excision of the intraurethral mesh is the recommended treatment.

POSTOPERATIVE EVALUATION OF TENSION-FREE VAGINAL TAPE PROCEDURE

Objective To study the outcome of tension-free vaginal tape (TVT) for the treatment of stress urinary incontinence (SUI) in women with cystocele. Methods Forty-two patients with SUI confirmed by urodynamics underwent the TVT procedure under local anesthesia. A prolapse repair was done simultaneously. Results Mean TVT operation time was 26.29 minutes. Mean blood loss was 29.86 mL. Eighty-eight percent of the patients were able to micturate spontaneously within 12 hours and residual urine was less than 100 mL. And 12% of the patients had to use indwelling catheter for 3-11 days. Average hospital stay was 2.91 days. Eighty-eight percent of patients were discharged within 2 days. All patients were followed up (an average of 10.26 months). According to subjective and objective assessment of the outcome, 39 patients (93%) were cured, another 3 patients (7%) were significantly improved and none was failed. There were no major complications such as bladder injury occurred. Conclusion TVT procedure is a minimal invasive, effective, and safe surgery for treatment of SUI.

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.

Fascinating history of groin hernias:Comprehensive recognition of anatomy,classic considerations for herniorrhaphy,and current controversies in hernioplasty

Groin hernias include indirect inguinal,direct inguinal,femoral,obturator,and supravesical hernias.Here,we summarize historical turning points,anatomical recognition and surgical repairs.Groin hernias have a fascinating history in the fields of anatomy and surgery.The concept of tension-free repair is generally accepted among clinicians.Surgical repair with mesh is categorized as hernioplasty,while classic repair without mesh is considered herniorrhaphy.Although various surgical approaches have been developed,the surgical technique should be carefully chosen for each patient.Regarding as interesting history,crucial anatomy and important surgeries in the field of groin hernia,we here summarized them in detail,respectively.Points of debate are also reviewed;important points are shown using illustrations and schemas.We hope this systematic review is surgical guide for general surgeons including residents.Both a skillful technique and anatomical knowledge are indispensable for successful hernia surgery in the groin.

腹腔镜下完全腹膜外Sublay治疗腰疝的疗效分析

目的探讨腹腔镜下完全腹膜外Sublay(TES)补片修补治疗腰疝的优势,分析腰疝修补术后的并发症。方法68例腰疝患者根据手术方式分为开放Sublay组30例和TES组38例,患者均使用轻质大网孔补片。观察2组手术时间、术中出血量、术后首次排气时间、术后6 h进食流质饮食情况、术后第1天和第3天疼痛视觉模拟量表(VAS)评分、术后住院时间、术后2周恢复非限制性活动情况、并发症情况及术后腰疝复发情况。依术后并发症的情况为分并发症组22例和无并发症组46例。分析腰疝术后并发症特征。结果与开放Sublay组比较,TES组手术时间差异无统计学意义,术中出血量减少、术后首次排气时间更早、术后第1天和第3天疼痛VAS评分更低、术后6 h恢复进食比例更高、术后住院时间缩短、2周恢复非限制性活动比例增加、并发症发生率降低(P<0.05)。所有手术患者术后随访周期内均未复发。与无并发症组比较,并发症组年龄≥60岁、继发腰疝、疝囊直径≥5 cm、术前嵌顿、开放Sublay、手术时间≥100 min、术中出血量≥10 mL的比例较高(P<0.05)。结论腹腔镜下TES修补术治疗腰疝比开放Sublay修补手术具有恢复快、术后并发症少的优点,更加安全、有效。

输尿管坐骨孔疝的诊治进展

输尿管坐骨孔疝是盆底疝的一种罕见类型,该病临床症状缺乏典型性,受累输尿管可继发上尿路梗阻并进一步引起肾盂肾炎、腰腹痛、肾功能不全等。截至目前全世界报道的输尿管坐骨孔疝患者不足40例,临床医师对输尿管坐骨孔疝的诊治水平有待强化。目前输尿管坐骨孔疝常用的治疗方法包括积极监测、手法复位、输尿管支架置入术、外科手术修补,其中腹腔镜下疝修补术的安全性和有效性逐渐得到认可。本文就输尿管坐骨孔疝诊治方法的最新进展进行综述。

腹腔镜经腹腹膜前疝修补术对青年患者睾丸血管及生殖功能的影响

目的:探讨腹腔镜经腹腹膜前疝修补术对青年患者睾丸血管及生殖功能的影响。方法:纳入2018年6月至2020年1月行腹腔镜经腹腹膜前疝修补术的32例男性患者作为研究对象,分别于术前1 d及术后1个月、6个月进行超声检查,测量患者双侧精索静脉内径、睾丸体积、睾丸动脉内径、睾丸动脉收缩期峰值血流速度等指标,并常规检测外周血清睾酮浓度、国际勃起功能指数。结果:32例手术均获成功。术后1个月,患侧精索静脉管径较术前明显增粗(P<0.05);术后6个月,测量管径与术前相比差异无统计学意义(P>0.05)。术后1个月、6个月,患者外周血清睾酮浓度、国际勃起功能指数、睾丸体积、睾丸动脉内径、睾丸动脉收缩期峰值血流速度与术前相比差异无统计学意义(P>0.05)。结论:腹腔镜经腹腹膜前疝修补术后早期可影响患侧精索静脉内径,术后6个月即可恢复正常,治疗青年腹股沟疝是安全、可靠的,不会影响患者的睾丸血管及生殖功能。

腹腔镜下经腹腔腹膜前疝修补术治疗嵌顿性股疝的临床效果研究

目的:探讨腹腔镜下经腹腔腹膜前疝修补术(TAPP)在治疗嵌顿性股疝方面的安全性及有效性。方法:回顾分析2017年4月—2021年12月天津中医药大学第一附属医院收治的30例嵌顿性股疝患者的临床资料,根据手术方式分为腹腔镜组17例,开放组13例,比较两组患者的手术情况、住院时间、并发症及随访结果等。结果:腹腔镜组手术时间[(71.35±10.48)min vs(86.90±12.54)min,P=0.010]、术中出血量[(17.06±3.40)m L vs(33.69±6.55)m L,P<0.001]、住院天数少于开放组[(5.90±1.30)d vs(8.23±9.93)d,P<0.001],术后疼痛评分低于开放组[(1.12±0.33)vs(2.09±0.70),P<0.001],术后排气时间短于开放组[(14.82±4.20)h vs(21.64±3.17)h,P<0.001],差异均有统计学意义;两组术后并发症无统计差异,术后随访1年,两组患者均未见复发。结论:TAPP手术治疗嵌顿性股疝是安全有效的,具有减少手术时间及出血,促进患者康复的优势。

弓状线变异对经弓状线单孔腹腔镜全腹膜外腹股沟疝修补术的影响

目的:探讨人体弓状线位置变异对经弓状线入路单孔腹腔镜全腹膜外疝修补术的影响。方法:回顾分析2021年1月至2022年7月收治的80例腹股沟疝患者的弓状线位置,根据脐至弓状线的距离分为3组,经典组(4~5 cm)、高位组(<4 cm)、低位组(>5 cm)。记录3组手术时间、出血量、术后并发症、术后第1天疼痛评分。结果:80例患者中经典组40例(50%),高位组17例(21.25%),低位组23例(28.75%),低位组手术时间、术后住院时间长于高位组与经典组,手术出血量多于高位组与经典组,术后疼痛评分高于高位组与经典组,差异有统计学意义(P<0.05)。3组腹膜损伤、皮下气肿发生率差异无统计学意义(P>0.05)。结论:弓状线变异对经弓状线入路的单孔全腹膜外疝修补术存在一定影响,了解变异情况利于进一步掌握该术式。

前列腺癌根治术后腹股沟疝的风险因素及预防策略

腹股沟疝(IH)是前列腺癌患者行前列腺癌根治术(RP)后常见的并发症,严重影响患者术后的生活质量,且术后并发IH的修补往往因之前手术导致的腹股沟区粘连而具有挑战性。本文综述近些年针对RP并发IH的风险因素,如手术方式、术后解剖结构改变、低身体质量指数、肌肉减少症、高龄、国际前列腺症状评分、鞘状突未闭等,并结合相关研究阐述临床常用的预防策略包括机器人辅助腹腔镜根治性前列腺切除术(RARP)联合IH修补术、保留耻骨后间隙的RARP、精索的处理、经腹膜外RARP、术中鞘状突的处理等,以期为临床泌尿外科医师提供参考,帮助改善患者术后生活质量。

亚高原地区腹腔镜疝修补术和子宫切除术患者全身麻醉期间不同吸入氧浓度对术后恢复的影响

目的探讨亚高原地区腹腔镜疝修补术和子宫切除术患者全身麻醉期间不同吸入氧浓度对术后恢复的影响。方法收集2022年4月至2023年11月西宁市大通回族土族自治县人民医院就诊的111例择期全身麻醉下行腹腔镜疝修补术和子宫切除术患者的临床资料。根据患者全身麻醉过程中吸入氧浓度随机分为100%氧组(n=36)、80%氧组(n=38)和60%氧组(n=37)。比较3组患者麻醉诱导前、气腹30 min及术后第1天的动脉血氧分压(PaO_(2))、动脉血二氧化碳分压(PaCO_(2))和氧合指数(OI)等呼吸相关指标。比较3组患者首次排气时间,住院时间,术后肺部并发症、切口感染、谵妄及认知功能情况。结果气腹30 min时,3组PaO_(2)均在正常范围内;60%氧组PaO_(2)低于100%氧组和80%氧组(均P<0.001)。气腹30 min时,60%氧组OI高于100%氧组(P=0.009),而80%氧组与100%氧组OI比较无统计学差异(P>0.05)。与麻醉诱导前比较,3组术后第1天PaO_(2)和OI均降低(均P<0.05),PaCO_(2)均增高(均P<0.05)。术后第1天,60%氧组PaO_(2)和OI高于100%氧组和80%氧组(均P<0.05),60%氧组PaCO_(2)低于100%氧组(P<0.001);80%氧组PaO_(2)和OI均高于100%氧组(P<0.05)。与100%氧组比较,60%氧组首次排气时间显著缩短(P=0.019)。3组患者均未发生术后切口感染。3组住院时间,术后肺部并发症、谵妄和认知功能障碍发生率比较无统计学差异(均P>0.05)。结论亚高原地区腹腔镜疝修补术和子宫切除术患者全身麻醉期间,适当降低吸入氧浓度(60%)对患者术后呼吸和胃肠道功能恢复有积极作用,且不会增加患者切口感染、术后谵妄和认知功能障碍发生率。

Potential applications of single-incision laparoscopic totally preperitoneal hernioplasty

BACKGROUND The totally preperitoneal(TPP)approach is a new concept that was recently introduced.Although the TPP approach combined with single-incision laparoscopic hernia repair has its own advantages,there is little evidence reflecting the characteristics and feasibility of either approach.AIM To analyze the potential applications of single-incision laparoscopic TPP(SILTPP)inguinal hernia hernioplasty for the treatment of inguinal hernias.METHODS A total of 152 SIL-TPP surgeries were performed at the First Affiliated Hospital of Ningbo University from February 2019 to November 2022.A single-port,named Iconport,and standard laparoscopic instruments were used during the operation.Demographic data,intraoperative parameters and short-term postoperative outcomes were collected and retrospectively analyzed.RESULTS The demographic data of 152 patients underwent SIL-TPP were shown in Table 1.The average age was 49.5 years(range from 21 to 81 years).The average body mass index was 27.7 kg/m^(2)(range from 17.7 kg/m^(2) to 35.6 kg/m^(2)).SIL-TPP were conducted successfully in 147 patients.Three patients were converted to the SILtransabdominal preperitoneal laparoscopic herniorrhaphy at the initial stage of the study due to a lack of experience.In 2 patients with incisional hernias,an auxiliary operation hole was added during the SIL-TPP procedure,as required for surgery.The mean operative time was 64.5 minutes(range:36.0-110.0 minutes)for unilateral direct and femoral hernias and 81.6 minutes for indirect hernias(range:40.0-150.0 minutes).The mean postoperative hospital stay was 3.4 days.CONCLUSION SIL-TPP is feasible and has advantages for inguinal hernia repair.SIL-TPP has potential benefits for patients with various abdominal wall hernias.Consequently,doctors should be encouraged to actively apply the TPP approach combined with a single incision in their daily work.

右美托咪定滴鼻在小儿腹腔镜疝修补术中的镇痛镇静效果

目的 探讨右美托咪定滴鼻对小儿腹腔镜疝修补术中的镇痛镇静效果及拔管质量。方法 选取2021年3月至2022年9月在浙江省金华市妇幼保健院行腹腔镜疝修补术的患儿94例,根据不同麻醉用药分为右美托咪定组(47例)和0.9%氯化钠注射液组(47例),右美托咪定组采用1μg/kg右美托咪定滴鼻,0.9%氯化钠注射液组滴入等容量0.9%氯化钠注射液。比较2组患儿的拔管时间、苏醒时间及麻醉后监测治疗室(PACU)滞留时间,麻醉诱导前(T0)、插管即刻(T1)、插管后5 min(T2)、手术结束时(T3)、拔管即刻(T4)的平均动脉压(MAP)、心率、血氧饱和度(SpO_(2))水平,拔管后10、20、30、40 min疼痛视觉模拟评分(VAS)、 Richer镇静躁动评分(SAS)发生率。结果 T1、T2、T3、T4时观察组MAP、心率水平均低于对照组(P均<0.05),T1、T2、T3、T4时2组SpO_(2)水平差异无统计学意义(P>0.05),拔管后20、30、40 min时观察组VAS、SAS评分均低于对照组(P均<0.05);观察组拔管时间、苏醒时间及麻醉后PACU滞留时间及躁动发生率低于对照组(P均<0.05)。结论右美托咪定滴鼻能够有效稳定患儿血流动力学,有效改善对患儿的镇静镇痛,提升拔管质量。

腹腔镜完全腹膜外补片修补术对老年腹股沟疝患者的影响

目的:分析腹腔镜完全腹膜外补片修补术对老年腹股沟疝患者的影响。方法:回顾分析2017年1月至2023年9月收治的78例老年腹股沟疝患者的临床资料。按手术方法进行分组,观察组(n=39)行腹腔镜完全腹膜外补片修补术,对照组(n=39)行开放式完全腹膜外补片修补术。比较两组围术期指标、炎症因子水平、术后并发症。结果:观察组手术时间、术后疼痛持续时间、术后下床活动时间、术后住院时间均短于对照组,术中出血量少于对照组,疼痛评分低于对照组,差异有统计学意义(P<0.05)。术后第3天,观察组炎症因子水平低于对照组(P<0.05)。两组术后并发症发生率差异无统计学意义(10.26%vs. 7.69%,P>0.05)。结论:腹腔镜完全腹膜外补片修补术治疗老年腹股沟疝安全、可行,可优化各项手术指标,减轻炎症因子的水平。

腹腔镜下经腹腹膜前疝修补术与开放性疝修补术的疗效对比

目的:探析并比较腹股沟疝患者采取腹腔镜下经腹腹膜前疝修补术(TAPP)与开放性疝修补术治疗的效果,以期为患者寻求高效、安全的治疗方案。方法:纳入2021年1月—2023年8月丰城市中医院普外科收治的确诊为腹股沟疝的患者66例为分析对象,通过随机数字表法分为TAPP组、开放组,分别给予腹腔镜下TAPP、开放性疝修补术治疗,各33例。比较两组围手术期指标、疼痛程度、并发症发生情况及应激反应指标。结果:TAPP组术后恢复正常活动时间、术后住院时间均短于开放组,手术时间长于开放组(P<0.05);开放组与TAPP组术前视觉模拟评分法(VAS)评分对比,差异无统计学意义(P>0.05);术后两组VAS评分均低于术前,TAPP组VAS评分低于开放组(P<0.05);TAPP组并发症发生率低于开放组(χ^(2)=4.242,P<0.05);开放组与TAPP组术前应激反应指标[C肽、皮质醇(Cor)、去甲肾上腺素(NE)]对比,差异均无统计学意义(P>0.05);术后两组应激反应指标均高于术前,但TAPP组C肽、NE、Cor均低于开放组(P<0.05)。结论:腹股沟疝患者应用腹腔镜下TAPP治疗,相对于开放性疝修补术对患者机体的应激影响更小,术后疼痛更轻,恢复更快,并可降低并发症发生风险。

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.

腹腔镜经腹腹膜疝前修补术与开放无张力疝修补术治疗腹股沟疝的疗效及安全性

目的探究腹腔镜经腹腹膜疝前修补术(TAPP)与开放无张力疝修补术(OTFH)治疗腹股沟疝的疗效及安全性。方法选取2019年11月至2021年11月吉安市第一人民医院收治的91例腹股沟疝患者作为研究对象,按照随机数字表法分为对照组(n=45)与观察组(n=46)。对照组采用OTFH治疗,观察组采用TAPP治疗,比较两组手术时间、术中出血量、精索血管情况、疼痛情况及并发症发生率。结果两组手术时间比较差异无统计学意义;观察组术中出血量少于对照组,差异有统计学意义(P<0.05)。术后7d,两组精索动脉管径、精索静脉管径均宽于术前,精索动脉血流速度、精索静脉血流速度均慢于术前,但观察组精索动脉管径、精索静脉管径均窄于对照组,精索动脉血流速度、精索静脉血流速度均快于对照组,差异有统计学意义(P<0.05)。术后12h,观察组视觉模拟评分法(VAS)评分低于对照组,差异有统计学意义(P<0.05);术后24、48h,两组VAS评分均低于前一时间点,且观察组低于对照组,差异有统计学意义(P<0.05)。观察组并发症发生率为8.69%,低于对照组的24.44%,差异有统计学意义(P<0.05)。结论与OTFH治疗腹股沟疝患者相比,TAPP术中出血量更少,疼痛更轻,并发症发生率更低,对精索血管影响较小且不会延长手术时间,安全性更高。

疝环填充式无张力疝修补术与传统疝修补术在腹股沟疝治疗中的疗效比较

目的 探讨疝环填充式无张力疝修补术与传统疝修补术在腹股沟疝治疗中的疗效。方法 纳入2018年1月至2022年12月期间在我院普外科就诊的腹股沟疝患者76例,根据随机数字表法分组,对照组(38例)进行传统疝修补术治疗,观察组(38例)进行疝环填充式无张力疝修补术治疗,对比两组临床疗效、并发症发生情况、手术及术后恢复情况、视觉模拟评分量表(VAS)评分、术后复发率。结果 观察组的治疗总有效率为94.74%,高于对照组的78.95%(P <0.05);观察组的并发症发生率、术后2 h、术后第3天、术后第7天的VAS评分以及复发率均低于对照组(均P <0.05);观察组所需的手术时间、下床活动时间、住院时间、切口疼痛消失时间等手术及术后恢复指标均短于对照组(P <0.05)。结论 对腹股沟疝患者采取疝环填充式无张力疝修补术的疗效显著,可减轻术后疼痛感,缩短住院时间,促进患者早日康复。