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.

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.

Comparison of the application value of transvaginal ultrasound and transabdominal ultrasound in the diagnosis of ectopic pregnancy

BACKGROUND Ectopic pregnancy(EP) is one of the most common acute abdominal diseases in gynecology. Once the condition of EP is delayed, it may lead to massive hemorrhage, shock, and even death in a short time, seriously threatening the patient’s life. Early diagnosis is the key to preventing and improving the prognosis of EP.Transabdominal ultrasound(TAS) and transvaginal ultrasound(TVS) are the main diagnostic methods for abdominal diseases. The purpose of this study is to explore the application value and effect of TAS and TVS in the diagnosis of EP,hoping to provide more valuable references for the diagnosis of EP.AIM To explore the application value of TAS and TVS in the diagnosis of EP and to improve the level of clinical diagnosis.METHODS A total of 140 patients with EP admitted to our hospital from July 2018 to July 2020 were selected for this study. All patients were divided into two groups according to the examination methods. 63 patients who underwent abdominal ultrasound examination were set as the TAS group, while 77 patients who underwent TVS examination were set as the TVS group. We compared the diagnostic accuracy and misdiagnosis rates between the two types of ultrasound examinations, as well as the postoperative pathological results of the two diagnostic methods for different types of ectopic pregnancies. We also analyzed the sonograms for the presence of mixed ectopic masses,adnexal masses, ectopic gestational sacs, the presence or absence of visible embryo and fetal heart in the ectopic sac shadow, and the detection of fluid in the rectal fossa of the uterus, such as the adnexal area, yolk sac, and embryo, etc. In addition, the diagnosis time, days of gestational sac appearance, operation time, endometrial thickness, and blood flow resistance index were compared as well.RESULTS After performing both types of ultrasound examinations in 140 patients with EP, we found that the diagnostic accuracy of TVS was significantly higher than that of TAS, and the misdiagnosis rate was significantly lower than that of TAS. The differences were statistically significant(P < 0.05). In addition, the detection rate of TVS was better than that of TAS for the presence of mixed masses,adnexal masses, ectopic gestational sacs, the presence or absence of visible embryo and fetal heart in the shadow of the ectopic sac, and sonograms such as the adnexal area, yolk sac, and embryo,etc. The coincidence rate of its postoperative pathological examination results was significantly higher than those of TAS. The diagnosis time and the days of gestational sac appearance by TVS were significantly shorter than that by TAS, and the operation time was earlier than that by TAS.What’s more, the detection rates of the endometrial thickness ￡ 1.5 mm and blood flow resistance ￡0.5 were significantly higher in TVS diagnosis of EP than in TAS. All differences were statistically significant(P < 0.05).CONCLUSION Compared with TAS, TVS has the advantages of high detection accuracy and good sonogram performance.

Comparison of survival outcomes between transthoracic and transabdominal surgical approaches in patients with Siewert-Ⅱ/Ⅲesophagogastric junction adenocarcinoma:a single-institution retrospective cohort study

Objective： To compare the survival outcomes of transabdominal （TA） and transthoracic （TT） surgical approaches in patients with Siewert-II/III esophagogastric junction adenocarcinoma. Methods： This retrospective study was conducted in patients with Siewert-II/III esophagogastric junction adenocarcinoma who underwent either TT or TA operations in the West China Hospital between January 2006 and December 2009. Results： A total of 308 patients （109 in the TT and 199 in the TA groups） were included in this study with a follow-up rate of 87.3%. The median （P25, P75） number of harvested perigastric lymph nodes was 8 （5, 10） in the TT group and 23 （16, 34） in the TA group （P〈0.001）, and the number of positive perigastric lymph nodes was 2 （0, 5） in the TT group and 3 （1, 8） in the TA group （P〈0.004）. The 5-year overall survival （OS） rate was 36% in the TT group and 51% in the TA group （P=0.005）. Subgroup analysis by Siewert classification showed that 5-year OS rates for patients with Siewert II tumors were 38% and 48% in TT and TA groups, respectively （P=0.134）, whereas the 5-year OS rate for patients with Siewert III tumors was significantly lower in the TT group than that in the TA group （33% vs. 53%; P=0.010）. Multivariate analysis indicated that N2 and N3 stages, RI/R2 resection and a TT surgical approach were prognostic factors for poor OS. Conclusions： Improved perigastric lymph node dissection may be the main reason for better survival outcomes observed with a TA gastrectomy approach than with TT gastrectomy for Siewert III tumor patients.

Laparoscopic repair via the transabdominal preperitoneal procedure for bilateral lumbar hernia: Three cases report and review of literature

A lumbar hernia is a rare entity, and a bilateral lumbar hernia is much rarer. From May 2015 to October 2017, we treated only three patients with bilateral lumbar hernias. One patient came to the hospital presenting with right-sided abdominal pain, and the other two patients presented with bilateral lumbar masses. The previous bilateral lumbar hernia reported in the literature was repaired by open surgery. The laparoscopic approach via the transabdominal preperitoneal(TAPP) procedure with the self-gripping Parietex ProG rip? mesh was performed at our center. The laparoscopic repair was conducted by a skilled hernia surgeon, and was successfully performed in the three patients. The patients resumed a semiliquid diet and had no activity restriction after six hours following the operation. No antibiotics were used after the surgery. The operative times of the three patients were 120 min, 85 min, and 130 min. The blood loss volumes of the three patients were 20 mL, 5 mL, and 5 mL. The visual analogue scale pain scores of the three patients were 1, 2, and 2 on postoperative day 1, and were 1, 2, and 1 on postoperative day 3. No perioperative complications, such as bulge, wound infection and hematoma, occurred after the surgery. All of the patients were discharged on the third day after the operation. There was no chronic pain and no hernia recurrence during the follow-up. This study showed that the laparoscopic TAPP approach with the self-gripping mesh is safe and feasible, and can be considered an alternative method for the treatment of bilateral lumbar hernias.

Use of barbed suture for peritoneal closure in transabdominal preperitoneal hernia repair

AIM:To investigate the use of the V-Loc wound closure device for transabdominal preperitoneal hernia repair. METHODS:We performed conventional transabdominal preperitoneal hernia repair in 19 patients, including one single incisional case using V-Loc. Except for the use of V-Loc for peritoneal closure, the procedures were the same as those used in conventional techniques. RESULTS:Although the operators included 2 residents who have no experience in laparoscopic herniorrhaphy and intracorporeal suture, the operations were completed. We believe that V-Loc is especially suitable for inexperienced surgeons and the use of V-Loc reduces the operative time by a small amount but reduces operator stress significantly. CONCLUSION:We conclude that V-Loc is the ideal peritoneal closure device for transabdominal preperitoneal hernia repair.

Recurrent abdominal pain due to small bowel volvulus after transabdominal preperitoneal hernioplasty:A case report and review of literature

BACKGROUND Compared with open mesh repair,transabdominal preperitoneal(TAPP)hernioplasty results in less chronic postoperative inguinal pain and faster postoperative recovery.However,it may still lead to rare but serious complications.Here we report a case of intestinal volvulus with recurrent abdominal pain as the only clinical symptom,which occurred 3 mo after TAPP repair for bilateral inguinal hernia.CASE SUMMARY A 50-year-old male patient underwent laparoscopic TAPP for bilateral inguinal hernias.After the operation,he experienced recurring pain in his lower right abdomen around the surgical area,which was relieved after symptomatic treatment.Three months after the surgery,the abdominal pain became severe and was aggravated over time.The whirlpool sign of the mesentery was seen on contrast-enhanced computed tomography(CT).Laparoscopic exploration confirmed that a barb of the V-Loc™suture penetrated the peritoneum,which caused the adhesion of the small intestinal wall to the site of peritoneal injury,forming intestinal volvulus.Since there was no closed-loop obstruction or intestinal ischemia,recurrent abdominal pain became the only clinical manifestation in this case.After laparoscopic lysis of adhesions and reduction of intestinal volvulus,the patient recovered and was discharged.CONCLUSION The possibility of intestinal volvulus should be considered in patients who experience recurrent abdominal pain following TAPP surgery during which barbed V-Loc sutures are used for closing the peritoneum.Contrast-enhanced CT and active laparoscopic exploration can confirm the diagnosis and prevent serious complications.

Transabdominal Pre-Peritoneal Mesh for Inguinal Hernia Repair with External Fixation versus Mesh Stapling

Background: It is unknown whether stapling the mesh affects recurrence rate, incidence of neuralgia, and port-site hernia. We chose to fix it to the exterior reducing port size, cost and pain, at the same comparing this with traditional mesh stapling. Methods: We conducted a prospective trial for laparoscopic TAPP inguinal hernia repair on 120 patients in which we fixed the mesh to the anterior abdominal wall using either two prolene threads that passed to the exterior and tied in place or traditional mesh stapling. Results: The operative time is ranged from 35 to 70 minutes for external fixation, 30 to 60 minutes for mesh stapling, and 4 to 51 months for follow-up, and no recurrence occurred in both groups during the procedure. Two cases with post TAPP pain in mesh stapling patients are discussed with reduction of the cost and port size in external fixation patients. Conclusion: It is not necessary to secure the mesh during laparoscopic TAPP inguinal hernia repair from the interior and it is fixed only to the exterior allowing a reduction in size of the ports and considerable reduction in cost with elimination of TAPP associated post operative pain.

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.

Laparoscopic Transabdominal Preperitoneal Mesh Hernioplasty: A Medical College Experience

Objectives: To determine the feasibility and patient’s outcome of laparoscopic transabdominal preperitoneal mesh hernioplasty for inguinal hernias. Patients and Methods: This study was carried out from March 2011 to April 2014. A total of 130 patients underwent laparoscopic transabdominal preperitoneal mesh hernioplasty (TAPP) for uncomplicated inguinal hernia. Of this, 10 patients presenting with bilateral inguinal hernias were operated in the single sitting. A 15 cm × 12 cm polypropylene mesh was used in all cases. Operative morbidity, postoperative pain, seroma formation, evidence of superficial infection, chronic groin pain and hernia recurrence were noted. The majority of the patients were discharged within 24 hours and follow-up was done at 1 week, 1 month, and 6 months. Results: 130 patients presenting with uncomplicated inguinal hernias were operated over a period of three years in the department of surgery, Govt. Medical College Srinagar. The mean age of the patients was 39.18 years (range: 18 - 70 years). The median duration of operation was 48.5 minutes (range: 18 - 120 minutes). None of the procedure was converted to open inguinal hernia repair. Postoperative pain was observed in 9.23% of the cases and was easily controlled by oral analgesics. Six patients (4.62%) developed seroma, out of which one required aspiration while others settled conservatively. Two patients (1.54%) developed wound infection and one patient (0.77%) had recurrence. None of the patients developed scrotal hematoma or neuralgia. Return to normal activity after TAPP repair was found to be after a median of 16.1 days. Conclusion: Transabdominal preperitoneal repair for inguinal hernia using proline mesh may be a safe and effective procedure with low morbidity, early return to normal activity and with a very low recurrence after six months follow-up.

Clinical study in diagnosis of placental implantation abnormality with transabdominal Doppler ultrasound

Objective: To evaluate the ultrasonographic charateristics and the diagnostic value in placental implantation abnormality (PIA) with transabdominal Doppler ultrasound, and improve the rate of diagnosis accuracy in the prenatal and postnatal of PIA with transabdominal Doppler ultrasound, for early diagnosis and treatment, to avoid hysterectomy caused by fatal bleeding. Methods: There were 61 cases complicated with PIA by operation and pathologically confirmed in our hospital. 33 cases were prenatal PIA, and 28 cases were postnatal PIA. The sonographic characteristics of PIA were summarized, the sensitivity and false negative rate of transabdominal Doppler ultrasound were analyzed with the results of surgical and pathological diagnosis. Results: In the images of prenatal PIA, the incidence of abundant blood flow signals in muscular layer of the placenta was the highest, which could reached 85.7%, followed by placenta 'vortex' and placenta previa;placental remnants were major sonographic performance in postnatal PIA, the incidence rate was 100%, followed by abundant blood flow signals in muscular layer of the placenta and disappeared boundary between myometrium and placenta. 14 cases could be diagnosed as prenatal PIA accurately by transabdominal Doppler ultrasound, the sensitivity was 42.4%, and the false negative rate was 57.6%. 21 cases could be diagnosed as postnatal PIA accurately by transabdominal Doppler ultrasound, the sensitivity was 75.0%, and the false negative rate was 25.0%. Conclusions: The specificity was low in prenatal PIA by transabdominal Doppler ultrasound, but the false negative rate was high. If necessary, the diagnostic accuracy could be improved combined with MRI. The specificity was much higher in postnatal PIA, and the false negative rate was low. The ultrasonography of PIA has some certain characteristics, we should strengthen the consciousness of the diagnosis in PIA, especially in the prenatal PIA, and improve the auxiliary diagnosis.

Clinical outcome of transabdominally HellerDor operation for achalasia

Objective To evaluate the effect of curing achalasia by transabdominally Heller-Dor operation. Methods To summarize 33 cases of achalasia treated by transabdominally Heller-Dor procedure and visit them postoperatvely. 18 patients receive pre-and post-operative manometry and 24-hour-pH monitoring. The parameters including reflux frequency,the longest lasting-time of reflux,the total time (min) of pH 【4.0 and the percentage(%) of time of

Effect of two surgical approaches on the lung function and prognosis of patients with combined esophagogastric cancer

BACKGROUND Adenocarcinoma of the esophagogastric junction has a center of origin within 5 cm of the esophagogastric junction.Surgical resection remains the main treatment.A transthoracic approach is recommended for Siewert I adenocarcinoma of the esophagogastric junction and a transabdominal approach is recommended for Siewert III adenocarcinoma of the esophagogastric junction.However,there is a need to determine the optimal surgical approach for Siewert II adenocarcinoma of the esophagogastric junction to improve lung function and the prognosis of patients.AIM To investigate and compare the surgical effects,postoperative changes in pulmonary function,and prognoses of two approaches to treating combined esophagogastric cancer.METHODS One hundred and thirty-eight patients with combined esophagogastric cancer treated by general and thoracic surgeries in our hospital were selected.They were divided into group A comprising 70 patients(transabdominal approach)and group B comprising 68 patients(transthoracic approach)based on the surgical approach.The indexes related to surgical trauma,number of removed lymph nodes,indexes of lung function before and after surgery,survival rate,and survival duration of the two groups were compared 3 years after surgery.RESULTS The duration of surgery,length of hospital stay,and postoperative drainage duration of the patients in group A were shorter than those of the patients in group B,and the volume of blood loss caused by surgery was lower for group A than for group B(P<0.05).At the one-month postoperative review,the first second,maximum ventilation volume,forceful lung volume,and lung volume values were higher for group A than for group B(P<0.05).Preoperatively,the QLQ-OES18 scale scores of the patients in group A were higher than those in group B on re-evaluation at 3 mo postoperatively(P<0.05).The surgical complication rate of the patients in group A was 10.00%,which was lower than that of patients in group B,which was 23.53%(P<0.05).CONCLUSION Transabdominal and transthoracic surgical approaches are comparable in treating combined esophagogastric cancer;however,the former results in lesser surgical trauma,milder changes in pulmonary function,and fewer complications.

成人腹腔镜腹股沟疝修补术围手术期处理经验

自1982年Ger等施行首例腹腔镜疝修补术以来-[1],对于腹腔镜腹股沟疝修补技术的革新从未停止,1991年Toy与Smoot联合报道了腹腔镜腹腔内补片植入术（intraperitoneal onlay mesh,IPOM）-[2],同年,Arregui于美国内镜外科医师协会年会上首次报道了经腹腹膜前补片植入术（transabdominal preperitoneal,

腔镜腹股沟疝术式选择:TAPP vs.TEP

腹腔镜腹股沟疝修补术（laparoscopic inguinal hernia repair,LIHR）是20世纪90年代初期新兴的腹股沟疝修补术。目前主要包括两种方式：经腹腹膜前疝修补术（transabdominal preperitoneal,TAPP）与完全腹膜外疝修补术（totally extraperitoneal,TEP）。1990年Schultz等[1]在其出版的腹腔镜疝修补术系列从书中提出了＂transabdominal preperitoneal repair＂,这是目前检索到最早的TAPP的尝试。

Ultrasonography in diagnosing chronic pancreatitis: New aspects

The course and outcome is poor for most patients with pancreatic diseases.Advances in pancreatic imaging are important in the detection of pancreatic diseases at early stages.Ultrasonography as a diagnostic tool has made,virtually speaking a technical revolution in medical imaging in the new millennium.It has not only become the preferred method for first line imaging,but also,increasingly to clarify the interpretation of other imaging modalities to obtain efficient clinical decision.We review ultrasonography modalities,focusing on advanced pancreatic imaging and its potential to substantially improve diagnosis of pancreatic diseases at earlier stages.In the first section,we describe scanning techniques and examination protocols.Their consequences for image quality and the ability to obtain complete and detailed visualization of the pancreas are discussed.In the second section we outline ultrasonographic characteristics of pancreatic diseases with emphasis on chronic pancreatitis.Finally,new developments in ultrasonography of the pancreas such as contrast enhanced ultrasound and elastography are enlightened.

Role of endoscopic ultrasound in the diagnosis of pancreatic cancer

Endoscopic ultrasonography(EUS) with or without fine needle aspiration has become the main technique for evaluating pancreatobiliary disorders and has proved to have a higher diagnostic yield than positron emission tomography,computed tomography(CT) and transabdominal ultrasound for recognising early pancreatic tumors.As a diagnostic modality for pancreatic cancer,EUS has proved rates higher than 90%,especially for lesions less than 2-3 cm in size in which it reaches a sensitivity rate of 99% vs 55% for CT.Besides,EUS has a very high negative predictive value and thus EUS can reliably exclude pancreatic cancer.The complication rate of EUS is as low as 1.1%-3.0%.New technical developments such as elastography and the use of contrast agents have recently been applied to EUS,improving its diagnostic capability.EUS has been found to be superior to the recent multidetector CT for T stagingwith less risk of overstaying in comparison to both CT and magnetic resonance imaging,so that patients are not being ruled out of a potentially beneficial resection.The accuracy for N staging with EUS is 64%-82%.In unresectable cancers,EUS also plays a therapeutic role by means of treating oncological pain through celiac plexus block,biliary drainage in obstructive jaundice in patients where endoscopic retrograde cholangiopancreatography is not affordable and aiding radiotherapy and chemotherapy.

Diagnostic value of different color ultrasound diagnostic method in endometrial lesions

BACKGROUND Endometrial lesions include endometrial cancer and inferior fibroids.Among them,endometrial cancer as a malignant tumor seriously endangers the life and health of patients.Ultrasonography is an important means of diagnosing female reproductive system diseases,and it is of critical value for the early diagnosis of endometrial cancer.However,different ultrasound inspection programs have achieved different results.It is of great significance to choose a suitable inspection program.AIM To explore the diagnostic efficacy of different ultrasonic examination methods in clinical endometrial lesions.METHODS The 140 patients with endometrial lesions who were treated in our hospital from April 2018 to October 2019 were used as the research subjects.All patients underwent transvaginal color ultrasound and transabdominal color ultrasound.We compared the diagnostic coincidence and image display effects of the two different examination methods,and the endometrial thickness,blood flow,uterine effusion and resistance index of different diseases were observed by transvaginal color ultrasound.RESULTS The diagnostic coincidence rate of all types of diseases of transvaginal color ultrasound was significantly higher than that of transabdominal color ultrasound(P=0.001,0.005,0.001 and 0.001).In addition,the excellent and good rate of image display of transvaginal color ultrasound was higher than that of transabdominal color ultrasound(P=0.001).There were significant differences in endometrial thickness in patients with different types of endometrial lesions through the transvaginal color examination(P=0.001).The incidence rate of uterine effusion in patients with endometrial carcinoma was significantly higher than that in patients with other types of endometrial lesions(P=0.001),and the rate of the blood flow was the highest(P=0.001).The comparison of blood flow resistance index indicated that the blood flow resistance index in endometrial cancer patients was the lowest,which shows that the difference was statistically significant(P=0.001).CONCLUSION The overall diagnostic efficacy of transvaginal color ultrasound in the clinical diagnosis of endometrial lesions is better than that of transabdominal color ultrasound,which held higher diagnostic coincidence rate and image display effect.There were significant differences in the thickness of the endometrium and the blood flow in different types of lesions.

Retrorectal tumors:A challenge for the surgeons

Retrorectal or presacral tumors are rare lesions located in the presacral area and considered as being derived from multiple embryological remnants.These tumors are classified as congenital,neurogenic,osseous,inflammatory,or miscellaneous.The most common among these are congenital benign lesions that present with non-specific symptoms,such as lower back pain and change in bowel habit.Although congenital and developmental tumors occur in younger patients,the median age of presentation is reported to be 45 years.Magnetic resonance imaging plays a crucial role in treatment management through accurate diagnosis of the lesion,the evaluation of invasion to adjacent structures,and the decision of appropriate surgical approach.The usefulness of preoperative biopsy is still debated;currently,it is only indicated for solid or heterogeneous tumors if it will alter the treatment management.Surgical resection with clear margins is considered the optimal treatment;described approaches are transabdominal,perineal,combined abdominoperineal,and minimally invasive.Benign retrorectal tumors have favorable long-term outcomes with a low incidence of recurrence,whereas malignant tumors have a potential for distant organ metastasis in addition to local recurrence.