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.

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.

Urogenital Complications of Groin Hernia Surgery: A Multicentre Study in Guinea

Context and Objective: Groin hernia is a common pathology in visceral surgery (2nd rank after appendicitis), which affects approximately 4.6% of the African population. Restoring the normal anatomy of the groin region is one of the most benign interventions. However, uro-andrological complications are possible. This study aimed to contribute to the improvement of the management of urogenital complications of groin hernia surgery. Patients and Method: We carried out a prospective study of descriptive type with a duration of 6 months from 1 August 2021 to 31 January 2022. The data were collected using a pre-established survey sheet. The study covered several sites (public hospitals and private clinics) in Guinea. Results: The urogenital complications of the surgery of the hernia of the groin represented 15.22% or 14 cases out of 92 patients. The average age was 37.00 years with extremes of 20-69 years. Polygamists occupied the first place. The reason for consultation was dominated by decreased testicular volume (42.86%), followed by a desire to conceive (21.43%). Unilateral testicular atrophy represented 63.64%, bilateral 27.27%. We performed a left orchidectomy in one patient and a cystorraphy in another simple operative follow-up. The other cases consisting of testicular atrophy, due to lack of a suitable technical platform, did not benefit from any specific therapeutic treatment. Conclusion: Urogenital complications of groin hernia surgery are relatively common. Testicular atrophy was the main clinical complication. The left orchidectomy and cystorraphy were the therapeutic procedures performed.

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.

腹腔镜造口重做造口旁疝补片修补术的手术效果及安全性评估

目的:探讨运用造口重做法进行造口旁疝补片修补术的手术效果及手术安全性。方法:2009年5月至2010年8月,共对12例结肠造口旁疝病人运用IPST补片进行造口重做腹腔镜造口旁疝补片修补手术,包括10例腹腔镜修补术式和2例单孔腹腔镜修补术式。术后采用定期电话询问及门诊检查相结合的方法进行随访;随访内容包括:电话询问饮食,有无腹痛,排气、排便情况及造口情况;门诊进行腹部和造口检查及CT平扫。结果:12例手术均获成功,手术时间80～170 min,平均112 min;术后住院时间3～8 d,平均6 d;术后随访1～16个月,平均6个月。随访结果显示均未见复发;所有病例未见明显浆液肿和血清肿的发生;未发生与补片、手术相关的感染;无顽固性疼痛发生。修补区暂时性腹壁疼痛3例,均于术后4周内缓解。术后排气时间1～4 d,平均2 d,术后暂时性腹胀4例,术后排便不适、不畅4例;但均未发生因造口并发的肠梗阻。结论:运用IPST补片进行造口重做的腹腔镜造口旁疝补片修补术,手术技术上安全、可行,随访结果显示疗效较好,值得在临床推广应用。

腹膜前无张力修补腹股沟疝74例

目的探讨腹膜前腹股沟疝无张力修补手术的疗效,以及以疝囊为中心进行腹膜前游离并接受腹膜前无张力疝修补术的手术方法。方法应用美国巴德公司提供的定型产品内存弹力记忆环及定位袋的双层聚丙烯Kugel补片,以及北京天助畅运公司生产的善释腹膜前补片装置,对74例腹股沟疝患者进行以疝囊为中心腹膜前游离并行腹膜前无张力疝修补术。结果 74例均顺利完成手术,每例侧手术时间平均32 m in,术后6 h下床活动。患者术后无伤口感染、阴囊血肿,1例发生右侧阴囊积液,1例股疝大腿根部积液。术后平均住院时间4 d。术后随访1~48个月,未复发。结论该手术是一种安全有效的手术方式,手术操作简单,实用性强。

局麻下普理灵疝装置修补老年人腹股沟疝

目的:研究局麻下普理灵疝装置(PHS)疝修补术于老年疝病人的效果。方法:总计73例60岁以上腹股沟疝病人,按随机原则分组实施PHS或Lichtenstein方法治疗。收集的数据包括手术切口、操作时间、疼痛评分、并发症,复发率术后生活质量评估(SF-36)。结果:PHS组的手术时间缩短,住院天数减少,术后并发症减少,生活质量无差异。结论:局麻下PHS手术简便,术后恢复好。

局麻下超普疝装置修补老年腹股沟疝的应用

目的总结局麻下应用超普疝装置(UHS)治疗老年腹股沟疝的效果。方法应用1%利多卡因进行腹股沟区局部神经区域阻滞麻醉,对38例老年(>65岁)腹股沟疝患者行UHS开放式无张力疝修补术。结果 38例患者均治愈,平均手术时间48min,平均住院时间5天。术后出现尿潴留5例,阴囊积液1例,无术后切口及深部感染、慢性疼痛、睾丸萎缩等并发症发生。随访5～24个月(平均12个月)无复发,无明显异物感。结论局麻下应用UHS治疗老年腹股沟疝简单、安全、可靠。

腹腔镜腹股沟疝修补术(附38例报告)

目的：探讨腹腔镜经腹膜腹股沟斜疝无张力修补术（transabdominal preperitoneal prosthesis，TAPP）的安全性和有效性。方法：38例腹股沟疝患者均采用TAPP治疗，其中直疝9例，斜疝21例，股疝1例，双侧疝2例，复发疝5例。。结果：所有患者均手术成功，平均手术时间（40．3±15．8）min，平均住院时间（5．4±1．6）d，随访0．5～3年，均采复发。结论：TAPP是治疗腹股沟疝安全有效的方法。

三维双层补片治疗腹股沟疝

目的 探讨采用新型无张力三维双层补片修补术治疗腹股沟疝 ,及其减少腹股沟疝的术后并发症和复发率的效果。方法 分析行三维双层补片疝修补术 47例患者的临床资料。 47例均为男性。中位年龄 65岁。斜疝 3 6例 ,直疝 11例。该组患者的五六评分总得分均大于或等于 6分。术中广泛解剖腹股沟区 ,将疝囊完全剥离至疝囊颈后 ,通过内环口将腹横筋膜与腹膜分离。在将疝囊经内环送入腹腔的同时 ,将三维补片的下层片经内环置入腹横筋膜与腹膜之间的间隙 ,上层补片缝合在腹股沟韧带和弓状下缘上 ,形成一个对腹股沟区前后修补的三维结构。结果 术后患者无不良反应 ,术后第 1天即可下床活动 ,第 3天出院。全部患者随访 1～ 2年 ,均无不适感 ,手术部位未出现硬结 ,无复发。结论 该术式适用于“五六评分法”总分 >6分且腹股沟管后壁需要修补的患者。该手术方式符合人体解剖特点 ,手术后并发症和复发率少 ,值得临床推广。但手术方法较复杂 ,对手术者的手术技巧要求较高。

开放腹膜前疝修补手术的要点和难点

开放腹膜前疝修补手术能覆盖整个肌耻骨孔,达到全腹股沟修补,更符合人体工程力学原理,已在临床上广泛应用。Kugel手术作为经典的开放式腹膜前修补术,具有微创、免缝合固定、术后并发症少等优点,适用于绝大多数的腹股沟疝,但学习曲线较长。文中阐述通过对Kugel手术入路进行改良,大大缩短了学习曲线,术后并发症少,临床效果良好,并详细介绍了开放腹膜前疝修补手术的要点、难点。

局麻下普理灵疝装置修补45例老年患者腹股沟疝临床效果分析

目的:总结局麻下应用普理灵疝装置(PHS)治疗老年腹股沟疝的效果。方法:应用1%利多卡因进行腹股沟区浸润阻滞麻醉,对45例老年(>65岁)腹股沟疝行PHS开放式无张力疝修补术。结果:45例均治愈,平均手术时间46 min,平均住院5 d。术后出现尿潴留5例,阴囊积液1例,无术后切口及深部感染、慢性疼痛、睾丸萎缩等并发症发生。随访5～24个月(平均12个月)无复发,无明显异物感。结论:局麻下应用PHS治疗老年腹股沟疝简单、安全、可靠。

腹股沟疝不同疝修补术的疗效比较

目的 探讨腹股沟疝不同修补方法的临床效果。方法 对 10 8例腹股沟疝患者分别实施传统疝修补、无张力疝修补及腹腔镜疝修补的临床资料进行分析比较。结果 无张力疝修补的手术时间显著短于传统疝修补术 ,而腹腔镜疝修补的手术时间显著长于传统疝修补。无张力疝修补及腹腔镜疝修补术后患者的自主活动恢复时间、住院时间、手术并发症显著短于传统疝修补。随访至少 1年 ,传统疝修补 1例复发 ,无张力疝修补及腹腔镜疝修补均无复发。腹股沟疝修补后 ,患者的白细胞数、血清纤维蛋白原、C -反应蛋白和α -抗胰蛋白酶较术前显著增高。无张力疝修补及腹腔镜疝修补后上述指标与传统疝修补术后相比差异显著 (P <0 .0 5～P <0 .0 1)。结论 无张力疝修补及腹腔镜疝修补的近期疗效明显优于传统方法。尽管网塞及补片的应用可增强机体的炎性反应 ,但并不增加其伤口感染发生率。

Comparing the effects of Bassini versus tension-freehernioplasty: 3 years’ follow-up

In order to compare the effects of Bassini and tension-free mesh hernioplasty,a total of 552 patients with inguinal hernia who were subjected to surgical treatment in our hospital were randomly divided into the following two groups:the Bassini group(n=269)and the tension-free mesh group(n=283).The recurrence rates,pain,dis-comfort,and other complications were recorded,and the causes of the complications were explored.The recurrence rate in the Bassini group was 8.9%(24/269),significantly higher than that in the tension-free repair group(2.8%,8/283).In addition,the recurrence rates in the Bassini and tension-free groups before 2004 were 12.6%and 5.6%,respectively,which were markedly higher than the rates after 2004(5.3%and 0.7%,respectively).The rate of post-operative discomfort and pain within thefirst three months was higher in the Bassini group compared to the tension-free group(25.7%vs 18.5%,respectively).However,there was no difference after three months in the rate of post-operative discomfort and pain,incidence of infection,or scrotal edema between the two groups.The average hospital stay in the Bassini group was longer than that in the tension-free repair group(7.6�1.2 vs 4.5�2.2 days,respectively),but the cost was lower(4518.0�510 vs 6221.3�578 yuan,respectively).Thus,tension-free mesh hernioplasty is indicated for most inguinal hernia patients due to the low recurrence rate,rapid recovery time,and treatment success,but the traditional Bassini procedure has lower cost and other beneficial effects and is still suitable for some patients.

Efficacy and postoperative complication of tension-free vaginal tape-Secur for female stress urinary incontinence

Background As the third-generation tension-free tape for female stress urinary incontinence （SUI）, tension-free vaginal tape （TVT）-Secur has decreased the common complications associated with TVT and tension-free vaginal tape-transobturator （TVT-O）, such as bladder perforation and obstruction of the bladder outlet; but its efficacy and persistence were still controversial. The aim of this study was to prospectively evaluate and compare the postoperative efficacy and complication at different follow-up time.Methods Patients with SUI, who underwent lVT-Secur treatment in two hospitals from October 2008 to October 2009,were selected. By analyzing preoperative and intraoperative data and postoperative complications, the therapeutic effect and satisfaction at different follow-up stages were evaluated.Results A total of 30 female patients participated in this study. Patients were scheduled for follow-up at the 1st month,3rd month, 6th month and 12th month, while the cure rate was 83.3% （25 patients）, 66.7% （20 patients）, 63.3% （19patients） and 60.0% （18 patients） respectively and the overactive bladder （OAB） symptoms appeared in 11 patients （36.7%）, 10 patients （33.3%）, 6 patients （20%） and 7 patients （23.3%） respectively.Conclusion With the follow-up time becoming longer, TVT-Secur has a high recurrence rate of SUI, the therapeutic effect from the 3rd month to the 12th month is relatively persistent.

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.

腹股沟疝无张力修补术后慢性疼痛的相关因素分析

在过去的一百多年里,人们对腹股沟疝主要研究的方向是如何把手术做好,如何降低术后复发率,忽略了术后慢性疼痛的存在及危害。直至20世纪80年代,疝修补术后复发率得到有效控制后,术后慢性疼痛才逐渐被引起重视。如何减少其发生率,已经成为当今研究的热点。通过查阅文献,认为术者熟悉腹股沟区域的神经解剖学、积累丰富的手术经验和术中规范化操作,可降低腹股沟疝无张力修补术后慢性疼痛的发生率。