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.

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.

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。

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。

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.

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

腹股沟被采用阻止 nearshore 区域侵蚀并且控制流动的方向。然而，腹股沟结构和它的联系流动特征是本地侵蚀的主要原因。在这研究，我们调查流动模式在附近折射并且直角腹股沟。特别地，我们经分解在一条折射腹股沟附近比较流动特征并且学习能被使用各种各样的投射长度的一条直角腹股沟完成的精确性的度。比较流动特征，我们用一条折射腹股沟的近似代替了直角腹股沟。这代替在隧道在流动的最大的速度上有最少的效果。而且，我们调查了密度的分发温度和咸度的变量，和他们在直角腹股沟附近的流动特征上的效果。在 baroclinic 和 barotropic 条件的流动分析结果的比较表明流动特征价值为两个是很类似的折射并且直角腹股沟。腹股沟的几何学，即，直角或折射，在最大的速度上有小效果到相对平均速度。除了尖分离，在下游地折射的腹股沟的腹股沟的手臂长度比做在上游的折射腹股沟在另外的流动特征上有更少的效果。我们也相关关于各种各样的流动特征和腹股沟几何学的很多个非维的变量。这些比较显示在 thalweg 高度和到设计长度的隧道和腹股沟手臂长度的宽度之间的关联在 subcritical 流动不管内部速度用线性、非线性的公式被接近了。

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.

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.

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。

单孔腹腔镜自制疝针经皮完全腹膜外内环结扎术治疗小儿腹股沟斜疝715例

目的探讨单孔腹腔镜自制疝针经皮完全腹膜外内环结扎术治疗小儿腹股沟斜疝的方法与疗效。方法回顾性分析2018年9月至2020年6月福建医科大学附属泉州第一医院小儿外科收治的715例小儿腹股沟斜疝患者临床资料。男580例,女135例;单侧687例,双侧28例;男性患儿中右侧325例、左侧240例、双侧15例,女性患儿中右侧62例、左侧60例、双侧13例。分析男女比例、侧别占比情况、手术时间、术中出血量及术中发现对侧鞘状突未闭或隐性疝占比情况。结果715例均于腹腔镜下完成手术,无一例中转开放手术。术中发现对侧鞘状突未闭或隐性疝320例(46.5%,320/687),其中男性右侧140例(43.1%,140/325)、男性左侧115例(47.9%,115/240),女性右侧33例(53.2%,33/62)、女性左侧32例(53.3%,32/60)。术中因内环口内侧腹膜褶皱多导致疝针不能顺利通过35例(4.9%,35/715),均为男性,于脐下3 cm左右或脐旁置入一辅助抓钳辅助操作。手术时间:单侧10~15 min,平均12 min;双侧15~21 min,平均17 min。术中出血量0~1 mL。麻醉清醒后即进食。715例均于入院后24 h内出院。无一例损伤精索血管、输精管、腹壁下动脉,术后无一例阴囊肿胀。随访12~33个月(平均18.3个月),2例复发,1例出现线结反应,无一例出现睾丸萎缩、医源性隐睾、术后鞘膜积液。结论单孔腹腔镜自制疝针经皮完全腹膜外内环结扎术治疗小儿腹股沟斜疝创伤小、恢复快、复发率低、切口美观,可发现并同期治疗对侧鞘状突未闭或隐性疝,值得临床推广。

药师参与腹股沟淋巴漏的治疗管理实践

药师参与1例外阴癌根治术术后并发腹股沟淋巴漏的治疗,根据患者临床症状并结合相关文献资料,对该患者发生淋巴漏的原因进行分析,给予保守治疗(禁食、奥曲肽、营养支持治疗)后,患者腹股沟淋巴液量明显减少,直至消失后予以出院。药师提高查阅文献的能力,协助临床科学制定个体化治疗方案、全程提供药学监护,有利于安全、合理用药,缩短住院时间、减少住院费用,改善临床结局。

河口航道双丁坝影响下异重流运动特性

在河口地区,由密度梯度驱动而产生的异重流是影响航道内泥沙输移的重要因素之一。作为航道整治中常见的建筑物,丁坝群可以缓解航道的泥沙淤积问题、提高通航能力。为探究双丁坝对异重流运动特性的影响,运用粒子图像测速系统(PIV)开展了开闸式异重流实验,研究了在不同束窄系数情况下,航道异重流稳定阶段内的流场及湍流特性,并对比分析了异重流在两个丁坝位置特征断面处的单宽流量及总流量。结果表明,双丁坝改变了航道内的流场,异重流在经过束窄断面后会向第二个丁坝后部区域横向扩散,进而使得流速加大、高度降低;异重流在两个丁坝束窄断面的单宽流量近似相同,且与束窄系数无关;异重流在束窄断面的总流量与断面宽度成正比,在实际工程中可以通过适当调整丁坝长度来控制侵入航道的异重流总量。

脐缘单孔腹腔镜手术治疗小儿腹股沟管型隐睾的早期疗效

目的探讨脐缘单孔腹腔镜手术治疗小儿腹股沟管型隐睾的早期临床疗效。方法2020年9月~2022年3月我科对53例小儿腹股沟管型隐睾(左侧19例,右侧31例,双侧3例)采用腹腔镜镜头由内环口伸入腹股沟管并确定睾丸位置后,利用腹腔镜镜头顶住患侧鞘膜囊,沿腹股沟管下行入患侧阴囊,于阴囊底部腹腔镜头冷光源处做一横切口,腹腔镜镜头将鞘膜囊顶至切口外,打开鞘状突后拖出睾丸,横断鞘膜囊,必要时行精索和输精管的游离,无张力固定睾丸于患侧阴囊皮肤肉膜间。结果手术均顺利完成,无中转开放手术,术中探查见患侧内环口均未闭合,对侧内环口未闭合占单侧隐睾患儿42.0%(21/50),同期行高位结扎术。手术时间(35.5±6.6)min。53例术后3、6、12、18个月患侧阴囊彩超提示所有患儿患侧睾丸血供良好,未出现睾丸回缩、萎缩,患侧无腹股沟斜疝、鞘膜积液等并发症。术前彩超睾丸体积(0.69±0.25)ml,与末次随访(0.92±0.32)ml比较差异有统计学差异(t=13.083,P=0.000)。结论脐缘单孔腹腔镜手术治疗小儿腹股沟管型隐睾可行,不破坏患侧腹股沟管结构,能发现并同时结扎对侧鞘状突,短期疗效满意。

腹腔镜结合Bianchi手术治疗腹股沟型隐睾的效果观察

目的:探讨腹腔镜下Bianchi手术方式治疗腹股沟型隐睾患儿的手术效果及安全性。方法:选取我院2019年6月至2022年6月收治的120例腹股沟区隐睾患儿作为研究对象,采用简单随机分组方式将其分为研究组和对照组各60例,研究组采用腹腔镜下Bianchi手术方式治疗,对照组采用腹股沟横向小切口睾丸下降术治疗,对比两组的手术操作指标、手术前后血清性激素、白细胞介素-6(IL-6)、IL-8、超敏C反应蛋白(hs-CRP)、血清抗苗勒管激素(AMH)、抑制素B(INHB)水平变化,手术并发症的发生情况。结果:研究组的平均手术时间长于对照组,住院时间短于对照组,术中出血量、切口长度均小于对照组,差异均具有统计学意义(P<0.05);术前,研究组和对照组的基线血清T、E2、FSH、AMH、INHB水平比较,差异不具有统计学意义(P>0.05);术后3个月再次对上述各项血清激素指标进行检查,两组患儿血清AMH、INHB水平较本组术前显著升高,血清E2、FSH水平较本组术前显著降低,差异均具有统计学意义(P<0.05);在两组患儿手术后3个月上述各项指标组间进行对比,差异均无统计学意义(P>0.05);术前,研究组和对照组的基线血清IL-6、IL-8、hs-CRP水平比较,差异不具有统计学意义(P>0.05);术后1d,研究组的血清IL-6、IL-8、hs-CRP测定值均低于对照组,差异均具有统计学意义(P<0.05);两组患儿手术后1d的IL-6、IL-8、hs-CRP测定值均高于本组术前,差异均具有统计学意义(P<0.05);研究组并发症发生率为8.33%,低于对照组的28.33%,差异具有统计学意义(P<0.05)。结论:腹腔镜下Bianchi手术方式治疗腹股沟型隐睾患儿的手术效果肯定,并发症少,值得临床推广应用。