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.

Comparison of Flow Characteristics Around Refractive and Right-angled Groins in Barotropic and Baroclinic Conditions

Groins are employed to prevent nearshore areas from erosion and to control the direction of flow. However, the groin structure and its associated flow characteristics are the main causes of local erosion. In this study, we investigate the flow patterns around refractive and right-angle groins. In particular, we analytically compare the flow characteristics around a refractive groin and study the degree of accuracy that can be achieved by using a right-angle groin of various projected lengths. To compare the flow characteristics, we replaced the right-angle groin with an approximation of a refractive groin. This replacement had the least effect on the maximum velocity of flow in the channel. Moreover, we investigated the distribution of the density variables of temperature and salinity, and their effects on the flow characteristics around the right-angle groin. A comparison of the flow analysis results in baroclinic and barotropic conditions reveals that the flow characteristic values are very similar for both the refractive and right-angle groins. The geometry of the groin, i.e., right-angle or refractive, has little effect on the maximum speed to relative average speed. Apart from the angular separation, the arm length of the groin in downstream refractive groins has less effect on other flow characteristics than do upstream refractive groins. We also correlated a number of non-dimensional variables with respect to various flow characteristics and groin geometry. These comparisons indicate that the correlation between the thalweg height and width of the channel and groin arm＇s length to projection length have been approximated using linear and nonlinear formulas regardless of inner velocity in the subcritical flow.

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.

Current trends in the diagnosis and management of post-herniorraphy chronic groin pain

Inguinodynia(chronic groin pain) is one of the recognised complications of the commonly performed Lichtenstein mesh inguinal hernia repair.This has major impact on quality of life in a significant proportion of patients.The pain is classif ied as neuropathic and nonneuropathic related to nerve damage and to the mesh,respectively.Correct diagnosis of this problem is relatively difficult.A thorough history and clinical examination are essential,as is a good knowledge of the groin nerve distribution.In spite of the common nature of the problem,the literature evidence is limited.In this paper we discuss the diagnostic tools and treatment options,both non-surgical and surgical.In addition,we discuss the criteria for surgical intervention and its optimal timing.

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.

Acute appendicitis presenting with abdominal wall and right groin abscess:A case report

We report a case of right lower abdominal wall and groin abscess resulting from acute appendicitis. The patient was an 27-year-old man who had no apparent abdominal signs and was brought to the hospital due to progressive painful swelling of right lower abdomen and the groin for 10 d. Significant inflammatory changes of soft tissue involving the right lower trunk were noted without any apparent signs of peritonitis. Laboratory results revealed leukocytosis. Abdominal ultrasonography described the presence of abscess at right inguinal site also communicating with the intraabdominal region. Right inguinal exploration and laparotomy were performed and about 250 mL of pus was drained from the subcutaneous tissue and preperitoneal space. No collection of pus was found intraabdominally and subserous acute appendicitis was the cause of the abscess. The patient fully recovered at the end of the second post-operation week. This case reminds us that acute appendicitis may have an atypical clinical presentation and should be treated carefully on an emergency basis to avoid serious complications.

A Case of Local Groin Abscess Caused by Transfemoral Coronary Procedures

Bacterial infection due to coronary angiography is an uncommon but important complication of percutaneous coronary intervention (PCI) which is responsible for significant morbidity and extended hospital stay. The reasons for this symptom are still unclear. We report a case of local groin abscess two weeks after the latest procedure. The reasons responsible for the groin abscess in this case might be diabetes mellitus without being properly controlled, left ventricular (LV) systolic dysfunction, multiple operations in the same site, the usage of vascular closure device (VCD), and long time pressure after the procedure. We should pay enough attention to these risk factors in the future clinical practice to avoid this serious complication.

Single Incision Laparoscopic Transabdominal Preperitoneal Repair for Strangulated Groin Hernia

Introduction: Single incision laparoscopic surgery (SILS) has become more popular for various surgical procedures including hernia surgery. Initial results of SILS in elective hernia repair were comparable to those of conventional laparoscopic approaches. However the use of SILS in emergency case has not been widely reported. This study aimed to evaluate the feasibility of the use of single incision laparoscopic transabdominal preperitoneal (TAPP) repair for patients presenting with strangulated groin hernia. Method: Emergency single incision laparoscopic TAPP repair were performed in our unit from June 2011 onwards for selected patients. Retrospectively data including the patient demographics, operative time, type of hernia, hospital stay, complications and recurrence rate were collected and analyzed. Result: There were a total of five patients in this series from June 2011 to June 2012. The median age was 62 years old with a male to female ratio of 4:1. Four patients had unilateral hernia (one femoral and three inguinal hernias) and one had bilateral hernia (unilaterally strangulated femoral hernia and bilaterally reducible indirect inguinal hernia). The median operative time was 75 minutes for patients with unilateral repair. None of the patients required bowel resection. The conversion rate to either conventional laparoscopic or open repair was zero. The median hospital stay was 2 days. No major complication or recurrence was detected. Conclusion: This series showed that single port laparoscopic TAPP repair for strangulated groin hernia is a feasible option with no major complication reported.

The Groin Physiology Revisited

The purpose is to contribute new information to the existing body of knowledge of the physiology of the groin. In a prospective ultrasonographic study, after an informed consent, 10 men and 10 women who were intact in the groin areas of surgery or relevant disease were involved. For a comparison, additional groups of 5 men and 5 women with abdominal wall hernias, but with no groin hernias, and other 5 men with inguinal hernias were included. The distal descent of the internal oblique muscle during the Valsalva’s manoeuvre in men was 0.8 cm ± 0.1 and in women it was 0.3 cm ± 0.1 (p < 0.001);the plate of transversus abdominis muscle changed its initial configurations and took on the characteristics of aponeurosis. During the Valsalva manoeuvre the rectus abdominis muscle demonstrated a distal latero-caudal shift of its lateral margin. In individuals with failed mechanics of the abdominal wall, the rectus abdominus does not realize the protective function. The mobile anatomic structures in the groin are oriented in three frontal planes. It formulated the concept of a synchronous protective function of all myofascial structures in the groin. We established that the anatomic structures transform the inguinal canal into a hermetic entity, which protects both the ingunal canal and the spermatic cord.

A long journey： report of a case with pancreatic abscess extending to the groin

Acute pancreatitis is an inflammatory process with .variable involvement of regional tissue, remote organ systems, or both. Various complications of pancreatitis are common, including intra- or extrapancreatic fluid collections and development of a pancreatic pseudocyst or abscess, or even pancreatic tissue necrosis. Infected necrosis involves diffuse bacterial inflammation of necrotic pancreatic and peripancreatic tissue without significant pus collection. In contrast, a pancreatic abscess is a circumscribed collection of pus, usually in proximity to the pancreas, that is positive for bacteria, bounded by adjacent tissue and organs and has minimal amounts of associated necrosis.

Wind Pressure Distribution and Wind-induced Dynamic Response for Spatial Groined Latticed Vaults

The wind pressure distribution and wind-induced vibration responses of long-span spatial groined latticed vaults （SGLVs） were numerically simulated, which always are ones of the most important problems in the structural wind resistance design. Incompressible visco-fluid model was introduced, and the standard k - two equation model and semi-implicit method for pressure linked equation （SIMPLE） were used to describe the flow turbulence. Furthermore, the structural dynamic equation was set up, which is solved by Newmark-fl method. And several sort of wind-induced vibration coefficients such as the wind-induced vibration coefficient corresponding to the nodal displacement responses and wind loads were suggested. In the numerical simulation where the SGLV consisting of the cylindrical sectors with different curved surface was chosen as the example, the influence on the relative wind pressure distribution and structural wind-induced vibration responses of the closed or open SGLV caused by such parameters as the number of cylindrical sectors, structural curvature and the ratio of rise to span was investigated. Finally, some useful conclusions on the local wind pressure distribution on the structural surface and the wind-induced vibration coefficients of SGLV were developed.

Pedicled omentum for coverage of extra-abdominal vascular bypass graft in the groin

The omentum is a well-established pedicled flap for coverage of intra-abdominal and thoracic pathology, and as a free-flap for a multitude of applications. Its use as a pedicled flap for extra-abdominal applications other than those on the chest is less well described. Here we present a case where a pedicled omental flap was utilized to provide circumferential and buried coverage of an in-line ilio-femoral bypass graft well below the level of the inguinal ligament. The reach of the omentum was more than adequate, and the delicate nature of the flap provided excellent circumferential coverage of a cryo-vein bypass graft.

超声引导髂腹下/髂腹股沟神经阻滞复合全麻在小儿腹股沟手术的应用

目的探讨不同麻醉方案应用于小儿腹股沟手术中对患儿手术情况、术时生命体征、术后疼痛等的影响。方法以2023年4月—2024年4月期间行腹股沟手术的60例患儿作为研究对象,病例均来自广东省高州市人民医院,采用随机数字表分为对照组与观察组,每组30例。对照组行常规气管插管全麻,观察组结合上述操作行超声引导髂腹下/髂腹股沟神经阻滞。比较两组手术一般指标、手术全程生命体征状态、术后疼痛程度、苏醒期躁动及术后不良反应发生情况。结果观察组手术大部分时间生命体征指标均较对照组稳定,观察组患儿苏醒所需时间、PACU停留时间、丙泊酚总用量、术后各时期FLACC评分均低于对照组,差异有统计学意义(P<0.05或0.001);观察组患儿苏醒期躁动及总不良反应发生率均低于对照组,差异有统计学意义(P<0.05)。结论髂腹下/髂腹股沟神经阻滞复合全麻效果明确,能够减少患儿麻醉药物使用量,缩短苏醒时间及PACU停留时间,并使患儿手术过程中生命体征更为平稳,同时对患儿造成的不良影响更小。

Single-incision laparoscopic transabdominal preperitoneal repair in the treatment of adult female patients with inguinal hernia

BACKGROUND Women have a 3%lifetime chance of developing an inguinal hernia,which is not as common in men.Due to its cosmetic benefits,single-incision laparoscopic transabdominal preperitoneal(SIL-TAPP)inguinal hernia repair is becoming in-creasingly popular in the management of inguinal hernia in women.However,there are no studies comparing the safety and applicability of SIL-TAPP repair with conventional laparoscopic transabdominal preperitoneal(CL-TAPP)inguinal hernia repair for the treatment of inguinal hernia in women.AIM To compare the outcomes of SIL-TAPP and CL-TAPP repair in adult female patients with inguinal hernia and to estimate the safety and applicability of SIL-TAPP repair in adult female inguinal hernia patients.METHODS We retrospectively compared the clinical information and follow-up data of fe-male inguinal hernia patients who underwent SIL-TAPP inguinal hernia repair and those who underwent CL-TAPP inguinal hernia repair at the Affiliated Hos-pital of Nantong University from February 2018 to December 2020 and assessed the long-term and short-term outcomes of both cohorts.RESULTS This study included 123 patients,with 71 undergoing SIL-TAPP repair and 52 un-dergoing CL-TAPP repair.The two cohorts of patients and inguinal hernia charac-teristics were similar,with no statistically meaningful difference.The rate of intraoperative inferior epigastric vessel injury was lower in patients in the SIL-TAPP cohort(0,0%)than in patients in the CL-TAPP cohort(4,7.7%)and was significantly different(P<0.05).In addition,the median[interquartile range(IQR)]total hospitalization costs were significantly lower in patients in the SIL-TAPP cohort[$3287(3218-3325)]than in patients in the CL-TAPP cohort[$3511(3491-3599)].Postoperatively,the occurrence rate of trocar site hernia was lower in the SIL-TAPP cohort(0,0%)than in the CL-TAPP cohort(4,7.7%),and the median(IQR)cosmetic score was significantly higher in the SIL-TAPP cohort[10(10-10)]than in the CL-TAPP cohort[9(9-10)].CONCLUSION SIL-TAPP repair did not increase the incidence of intraoperative and postoperative complications in female in-guinal hernia patients.Moreover,female inguinal hernia patients who underwent SIL-TAPP repair had a lower probability of trocar site hernia and inferior epigastric vessel injury than female inguinal hernia patients who un-derwent CL-TAPP repair.In addition,female inguinal hernia patients who underwent SIL-TAPP repair reported a more aesthetically pleasing postoperative abdominal incision.Therefore,SIL-TAPP repair is a better option for the treatment of inguinal hernias in women.

Reliability of the K-Force Muscle Controller Dynamometer on Eccentric and Isometric Hip Adduction Strength

Hip adduction strength tests are commonly used in clinical practice to provide an accurate diagnosis of groin injuries. Athletes with reduced adductor muscle strength are at risk of developing groin injuries. Our study aimed to evaluate the relative and absolute test-retest reliability of the side-lying eccentric hip adduction strength test and the long-lever adduction squeeze test using the K-Force hand-held dynamometer. Twenty physically active male individuals with a mean age (±SD) of 30.7 (±7.3) years were included. Both tests presented excellent test-retest reliability (Intraclass Correlation Coefficient: 0.77 - 0.95). The best and mean scores of the eccentric and isometric tests presented the smallest test-retest variation (MDC%: 12.8 - 14.9 and MDC%: 14.6 - 18.7, respectively). Our study showed that the K-Force dynamometer has excellent reliability for assessing hip adduction strength in two different testing positions. We suggest the best and mean of three repetitions for clinical practice as they present the lowest variability. Further research evaluating its clinimetric properties in different populations and gender is recommended.

Ultrasound-Guided Athletic Pubalgia Prolotherapy: A Novel Treatment

Research background: Athletic Pubalgia is a common, debilitating sports condition encountered by athletes who participate in competitive sports requiring pivoting movements. Athletic Pubalgia is often multifactorial with several pathologies overlapping to cause groin pain. Soft tissue disruptions at the insertions of adductor longus and rectus abdominis to the pubic symphysis are often encountered. Prolotherapy is the method of injecting an irritant solution into a joint space, ligament or tendon insertion site. The solution is thought to induce a regenerative response in the affected area through several mechanisms, including the induction of inflammation and vascular reconfiguration. Research objectives: The use of prolotherapy to treat Athletic Pubalgia has not been reported. The aim of this study was to assess ultrasound-guided prolotherapy as a therapeutic option in the treatment of Athletic Pubalgia. Methods: A case report, with informed consent (human material or human data were performed in accordance with the Declaration of Helsinki), involving a 24-year-old female presenting with Athletic Pubalgia. The patient presented with severe chronic right groin pain sustained while playing camogie. Conservative management options, including rest and rehabilitation with physiotherapy had failed to control this pain. Through dynamic ultrasound scanning, focal lesions were identified in the insertions of rectus abdominis and adductor longus to the pubic symphysis. Prolotherapy with 5% dextrose to the affected areas was performed. Assessment of analgesic and rehabilitation response was planned. Results: A sustained analgesic effect was observed at clinical follow-up at 6 weeks. Patient returned to full sporting activity. Conclusions: Ultrasound-guided prolotherapy has not yet been described as a treatment option in Athletic Pubalgia. In this case report, it was an effective pain-relieving therapy with improved rehabilitation. Larger studies are required to evaluate its efficacy.

腹股沟浅层淋巴结及其营养血管的解剖学研究

目的 明确腹股沟浅层淋巴结的数量、大小、分布规律及其营养动脉的来源与外径,为临床带淋巴血管蒂皮瓣移植、淋巴结移植治疗肢体水肿等提供解剖学依据。方法 对4具(8侧)成年尸体的腹股沟区进行解剖,以大隐静脉汇入股静脉处为原点划分象限,使用Photoshop测量法测量并统计各象限浅层淋巴结及其营养血管。结果 8侧共统计38个淋巴结,其中象限一(2.3±0.7)个,象限二(0.8±0.7)个,象限三(1.3±0.7)个,象限四(0.5±0.5)个。象限一分别与象限二,象限三,象限四比较,差异均有统计学意义(P<0.01)。淋巴结主要动脉来源与外径情况如下:象限一为旋髂浅动脉;腹壁浅动脉;股深动脉,(0.53±0.23)mm;象限二为旋髂浅动脉;腹壁浅动脉,(0.56±0.09)mm;象限三为股深动脉,(0.81±0.17)mm;象限四为股深动脉,(0.58±0.11)mm。结论 象限一内的淋巴结数量多于其他三个象限,且面积相对较小,营养动脉外径大小满足显微外科血管缝合要求,可作为临床带淋巴血管蒂皮瓣移植、淋巴结移植的备选区域。

钱塘江河口盐官段混合式丁坝修建对水沙及河床影响的实测研究

钱塘江北岸古海塘堤脚加固工程中,辅助围堰施工的临时性管袋黏土混合式丁坝对工程的顺利进行、提高施工效率起着至关重要的作用,然而目前对其周围水沙运动的研究较少,且缺乏相关实测资料。考虑混合式丁坝修建的动态过程,利用无人机拍摄水流视频结合LSPIV(粒子图像测速)处理技术对丁坝修建前、中、后期周围的流场进行分析,并对丁坝附近的地形进行跟踪测量,同时对不同潮差的水流含沙量进行现场测定。结果表明,丁坝具有改变水流方向,减少水流对河岸冲刷的作用,且丁坝越长,挑流作用越明显,为围堰施工提供了较为平缓的水流条件;混合式丁坝对坝后处的促淤效果明显,且坝后地形变化与含沙量密切相关,潮差越大,水体含沙量越高,丁坝后河床淤积幅度越大,有利于提高围堰的施工效率。研究成果对之后相关物理模型和数值模拟的研究提供数据支持。

Microstructure and mechanical properties of AZ61 magnesium alloy prepared by repetitive upsetting-extrusion

The process of repetitive upsetting-extrusion （RUE） was used to achieve severe plastic deformation （SPD） for an as-cast AZ61 magnesium alloy in temperature range of 285-380 ℃. The microstructure and mechanical properties of the as-cast and RUE processed AZ61 alloys were investigated. The results indicated that homogeneous fine-grained structure with mean grain size of 3.5 μm was obtained as the accumulated true strain in the axial direction increased to 4.28 after three RUE passes at 285 ℃. The dominant reason of grain refinement was considered the dynamic recrystallization induced by strain localization. It was also found that the microstructural evolution was affected by temperature and accumulated deformation. The mechanical properties of RUE processed AZ61 alloys were significantly improved owing to grain refinement. Furthermore, the relationship between deformation parameters and mechanical properties of AZ61 alloy prepared by RUE processing was revealed by tensile tests carried out at room temperature.

《腹股沟疝诊治国际指南更新版(2023)》解读

自2018版《腹股沟疝诊治国际指南》制定以来,不断有新的研究证据被报道。2023年10月国际疝外科组织在评估和筛选新证据后公布《腹股沟疝诊治国际指南更新版(2023)》。更新版对原指南的8个章节进行更新,共提出20个关键问题,制定39项新声明和32项推荐意见,其中16项为强烈推荐。本文结合临床关注的问题,对更新版进行梳理和解读。