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.

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.

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.

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.

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.

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。

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。

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.

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.

广东省某堤防丁坝群护岸效果数值模拟分析

研究通过数值模拟方法,对广东省某堤防丁坝群的护岸效果进行了分析。通过比较丁坝修复前后的水位变化、水流速度和岸坡稳定性,以及水流冲蚀对丁坝稳定性的影响,得出了关于修复工程效果和水流冲蚀影响的详细结论。研究结果可为广东省某堤防丁坝群的维护和修复提供科学依据。

U型弯道内L型丁坝群对不同水位水流水力特性影响试验研究

弯道影响通航的同时,易造成水土流失、河床淤积等现象。L型丁坝群是一种常用的水利工程结构,能调整水流速度、改善水流动力学特性,用于保护河岸线、防止淤积。我国多数河流常年无固定水位,布置丁坝群后,不同水位下,丁坝群对水流特性的影响情况值得研究。为此,通过试验,使用粒子图像测速系统和无线水位测量系统,分别对水流流速和水位等物理量进行测量、记录,并通过Matlab软件分析了不同水位下丁坝群对水流的影响情况,得出如下结论:随着水位的增加,水流速度逐渐减小,丁坝群下游部分是防冲刷和淤积的最佳位置,且坝高水深比影响丁坝作用的发挥,当比值为2.5左右时,可使丁坝群的作用得到良好发挥,在工程设计中可予以考虑。

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.

完全腹膜外腹股沟疝修补术中探查对侧腹股沟区必要性的相关研究

目的探讨在进行完全腹膜外腹股沟疝修补术(TEP)时对对侧腹股沟区探查的必要性.方法回顾性分析2018年1月至2022年3月142例单侧腹股沟疝患者临床资料,依据手术方法的不同,按术中有无进行对侧腹股沟区探查,分为研究组71例(双腹腔镜TEP)和对照组71例(TEP).对比两组患者手术时间、术中出血量、住院费用、术后住院时间、对侧隐匿疝发现情况、术后并发症发生率.结果研究组手术时间为(95.35±32.25)min,对照组为(90.63±28.28)min,两组患者手术时间差异无统计学意义(t=0.927,P=0.356).研究组术中出血量为(6.87±5.38)mL,对照组为(7.03±4.51)mL,两组差异无统计学意义(t=-0.186,P=0.853).研究组住院费用为(18733.19±3655.51)元,高于对照组的(17063.71±1270.63)元,差异有统计学意义(t=3.635,P<0.001).研究组术后住院时间为(1.89±0.78)d,对照组为(1.73±0.77)d,两组差异无统计学意义(t=1.185,P=0.238).研究组术后并发症发生率为7%,而对照组为5.6%,两组差异无统计学意义(χ^(2)=0.119,P=0.731).研究组术中探查出对侧隐匿疝17例.两组均随访至2022年5月,研究组未发现对侧腹股沟疝,而对照组患者在随访过程中有6例患者发现了对侧腹股沟疝,两组患者差异有统计学意义(χ^(2)=6.265,P=0.012).结论TEP术中探查对侧腹股沟区极为必要,有利于提高隐匿疝的检出率,减少术后对侧疝发生率,从而降低再次手术率,有着良好临床应用价值.

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.

河流丁坝“BIM+”创新设计方法研究

丁坝设计常借助室内水槽、恒定水流试验进行,往往与实际情况相差较大。以大数据和现场试验为基础,采用BIM+冲刷微地形成图技术,通过现场修建试验丁坝群、河道自然行洪过程,确定试验丁坝群附近的冲刷微地形变化过程的三维水动力数学模型及相关参数。将治理河段设计洪水过程线作为模型的入流条件,利用三维水动力模型模拟拟建丁坝群的防护效果,通过不断优化、调整丁坝位置、长度、坝头结构等参数,使其达到水流流势平稳、水流结构稳定、冲刷坑小且冲淤平衡效果好的目的。