Potential applications of single-incision laparoscopic totally preperitoneal hernioplasty

BACKGROUND The totally preperitoneal(TPP)approach is a new concept that was recently introduced.Although the TPP approach combined with single-incision laparoscopic hernia repair has its own advantages,there is little evidence reflecting the characteristics and feasibility of either approach.AIM To analyze the potential applications of single-incision laparoscopic TPP(SILTPP)inguinal hernia hernioplasty for the treatment of inguinal hernias.METHODS A total of 152 SIL-TPP surgeries were performed at the First Affiliated Hospital of Ningbo University from February 2019 to November 2022.A single-port,named Iconport,and standard laparoscopic instruments were used during the operation.Demographic data,intraoperative parameters and short-term postoperative outcomes were collected and retrospectively analyzed.RESULTS The demographic data of 152 patients underwent SIL-TPP were shown in Table 1.The average age was 49.5 years(range from 21 to 81 years).The average body mass index was 27.7 kg/m^(2)(range from 17.7 kg/m^(2) to 35.6 kg/m^(2)).SIL-TPP were conducted successfully in 147 patients.Three patients were converted to the SILtransabdominal preperitoneal laparoscopic herniorrhaphy at the initial stage of the study due to a lack of experience.In 2 patients with incisional hernias,an auxiliary operation hole was added during the SIL-TPP procedure,as required for surgery.The mean operative time was 64.5 minutes(range:36.0-110.0 minutes)for unilateral direct and femoral hernias and 81.6 minutes for indirect hernias(range:40.0-150.0 minutes).The mean postoperative hospital stay was 3.4 days.CONCLUSION SIL-TPP is feasible and has advantages for inguinal hernia repair.SIL-TPP has potential benefits for patients with various abdominal wall hernias.Consequently,doctors should be encouraged to actively apply the TPP approach combined with a single incision in their daily work.

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.

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.

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.

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.

Obstructed labour caused by foetal congenital hydronephrosis. Trans-abdominal drainage of the hydronephrosis with resultant delivery per vagina

A case of a 25 year old 2 alive Patient, with obstructed labour with fetal death and delivery of the fetus up to the trunk caused by congenital Bilateral Hydronephrosis is presented. Obstetric examination on admission supported by Abdominal Ultrasound revealed Bilateral Hydronephrosis which was then drained per abdomen using needle and intravenous fluid giving set with eventual relief of the obstruction and vaginal delivery of the stillborn baby.

A New Alternative Technique for Preperitoneal Inguinal Hernia Repair: Using Groin Innominate Fascial Island Flap

Aim: Despite the fact that reported low recurrence rates and improvement results, optimal surgical technique for in-guinal hernia repair was not found and recurrence was not eliminated. We used firstly groin innominate fascial island flap to reinforce the weak inguinal tissue for the repair. Methods: From the February 2010 to December 2010, 15 patients (13 male and 2 female) with inguinal hernia underwent repair with using island groin innominate fascial flap. The follow-up period ranged from 8 to 12 months (mean, 10 months). Results: Seroma developed in one case. Others had not any complications. Conclusion: Because of our technique avoids from the complications and drawbacks of the prosthetic mesh, autograft and abdominal wall flaps, we think that the groin deep fascial flap can be a good alternative to prosthetic meshes for reconstruction of inguinal hernia repair.

腹腔镜引导腹膜前间隙神经阻滞用于小儿腹股沟疝囊结扎术镇痛临床研究

目的:探讨腹腔镜引导下腹膜前间隙阻滞用于小儿腹股沟斜疝疝囊高位结扎术术后镇痛的新方法。方法:33例全麻腹股沟斜疝患儿,主刀医生在腹腔镜引导下用疝气针分离患侧腹膜前间隙游离精索的同时,注入0.2%罗哌卡因0.5 ml/kg,观察并记录患儿不同时间点的血流动力学指标、气道压、二氧化碳分压(PaCO_(2))、手术时间、麻醉时间、苏醒时间、术后镇痛时间、麻醉及手术并发症、改良警觉/镇静观察评估法(MOAA/S)评分、采用FLACC评分评估疼痛情况。结果:不同时间点收缩压、舒张压、平均动脉压、SpO_(2)等血流动力学指标差异无统计学意义(P>0.05);平均麻醉时间为(39.21±4.49)min,手术时间(20.15±3.96)min,苏醒时间(7.73±2.76)min;插管后、手术开始时、手术结束时PaCO_(2)差异无统计学意义(P>0.05);气道压手术开始时>手术结束时>插管后;手术结束、术后2 min、术后4 min、术后6 min、术后8 min、术后10 min的MOAA/S评分为:(0.30±0.88)、(1.18±1.38)、(2.48±1.50)、(3.30±1.36)、(4.48±0.80)、(4.97±0.17)分;拔管时、术后6 h、12 h、24 h的FLACC评分为:(0.36±1.03)、(0.45±0.67)、(1.27±0.84)、(1.36±0.60)分;术后镇痛时间(12.09±3.49)h;未见麻醉及手术并发症。结论:腹腔镜引导下患侧腹膜前间隙注入0.2%罗哌卡因0.5 ml/kg,小儿腹股斜沟疝疝囊高位结扎术术后镇痛安全、有效。

基于ERAS的优质护理在TAPP围手术期的应用研究

目的:探讨腹膜前腹腔镜腹股沟疝修补术(TAPP)围手术期患者采用基于加速康复外科(ERAS)的优质护理效果。方法:选取2021年1月—2023年10月常熟市第一人民医院收治的共计100例接受TAPP患者,以随机数字表法分成干预组(50例)与对照组(50例),对照组采用常规护理,干预组采用基于ERAS的优质护理,两组均干预至患者出院,比较两组围手术期指标、情绪状态、自我护理能力、生活质量。结果:干预组首次排气、术后下床活动均早于对照组,住院时间较对照组短,差异均有统计学意义(P<0.05);干预后两组汉密尔顿焦虑量表(HAMA)、汉密尔顿抑郁量表(HAMD)评分均下降,干预组均较对照组低,差异均有统计学意义(P<0.05);干预后两组自我护理能力量表(ESCA)各维度评分均升高,干预组均较对照组高,差异均有统计学意义(P<0.05);干预后两组世界卫生组织生存质量测定量表简表(WHOQOL-BREF)各维度评分均升高,干预组均较对照组高,差异均有统计学意义(P<0.05)。结论:基于ERAS的优质护理应用于TAPP围手术期患者中,能够缩短围手术期恢复时间,改善情绪状态,提高自我护理能力及生活质量。

4K高清腹腔镜下经腹腹膜前修补术治疗老年腹股沟疝的临床研究

目的探究4K高清腹腔镜下经腹腹膜前修补术治疗老年腹股沟疝的临床效果及安全性。方法选取2018年1月至2022年7月如皋市中医院收治的92例老年腹股沟疝患者的病历资料行回顾性分析,按治疗方案分为2组。对照组42例,采用常规腹腔镜经腹腹膜前修补术治疗;研究组50例,采用4K高清腹腔镜联合经腹腹膜前修补术治疗。比较2组患者手术相关指标、术后疼痛程度[视觉模拟量表(VAS)评分法评估]、血气指标[动脉血二氧化碳分压(PaCO_(2))、动脉血氧分压(PaO_(2))、pH值]、血清炎症因子水平[血清C反应蛋白(CRP)、白细胞介素⁃6(IL⁃6)],记录术后并发症发生率。结果研究组手术时间长于对照组,首次下床活动时间、住院时间短于对照组(P<0.05)。术前及术后48 h,2组患者的PaCO_(2)、PaO_(2)、pH值组间及组内差异均无统计学意义(P>0.05)。研究组术后24、48、72 h的VAS评分均低于对照组(P<0.05)。术后48 h,2组患者的CRP、IL⁃6均降低,且研究组低于对照组(P<0.05)。2组患者术后并发症发生率及复发率比较差异无统计学意义(P>0.05)。结论4K高清腹腔镜联合经腹腹膜前修补术治疗老年腹股沟疝,在促进患者术后恢复、减轻术后疼痛反应方面更具优越性,而相对于常规腹腔镜经腹腹膜前修补术,其手术时间稍长。

不同术式治疗腹股沟疝患者的效果

目的:比较腹腔镜经腹腹膜前腹股沟疝修补术(TAPP)、腹腔镜全腹腹膜外腹股沟疝修补术(TEP)与传统无张力疝修补术治疗腹股沟疝患者的效果。方法:选取2021年3月至2023年1月该院收治的141例腹股沟疝患者进行前瞻性研究,依据随机数字表法将其分为传统组、腹腔镜A组、腹腔镜B组各47例。传统组行无张力疝修补术治疗,腹腔镜A组行TAPP治疗,腹腔镜B组行TEP治疗,比较三组围术期指标水平、术后疼痛程度[视觉模拟评分法(VAS)]评分、手术前后应激指标水平[皮质醇(Cor)、去甲肾上腺素(NE)、促肾上腺皮质激素(ACTH)]水平、术后1周内并发症发生率和随访3个月的复发率。结果:腹腔镜A、B组手术时间、肠道功能恢复时间均长于传统组,下床活动时间均短于传统组,术中失血量均少于传统组,差异有统计学意义(P<0.05);腹腔镜B组手术时间、下床活动时间均短于腹腔镜A组,差异有统计学意义(P<0.05);腹腔镜A、B组术中失血量、肠道功能恢复时间比较,差异均无统计学意义(P>0.05);腹腔镜A、B组术后1 d、3 d和1周VAS评分比较,差异均无统计学意义(P>0.05);术后3d,三组血清ACTH、NE、Cor水平均高于术前1 d,但腹腔镜B组<腹腔镜A组<传统组,差异有统计学意义(P<0.05);三组并发症发生率、复发率比较,差异均无统计学意义(P>0.05)。结论:TEP、TAPP治疗腹股沟疝患者下床活动时间均短于传统无张力疝修补术治疗,术中失血量均少于传统无张力疝修补术治疗;TEP治疗腹股沟疝患者的手术时间、下床活动时间均短于TAPP治疗,应激指标水平均低于TAPP治疗和传统无张力疝修补术治疗,三种术式各有利弊。

腹股沟直疝腹腔镜下经腹腹膜前疝修补术术中三种不同假疝囊处理方法的效果比较

目的 探讨腹股沟直疝病人在腹腔镜下经腹腹膜前疝修补术(TAPP)术中分别采取旷置、单纯连续缝合法与环形缝合悬吊法处理假疝囊的手术效果。方法 2020年5月~2022年5月我院收治的腹股沟直疝病人120例,均行TAPP术治疗,按疝囊缺损部位处理方法分为三组:A组40例,采用假疝囊旷置术;B组40例,采用单纯连续缝合处理假疝囊;C组40例,采用环形缝合悬吊法处理假疝囊。对三组病人围手术期指标(手术时间、术中出血量、术后住院时间、住院费用)及术后效果(慢性疼痛、血清肿发生情况、切口或补片感染、异物牵拉感)进行比较。结果 120例病人均顺利完成TAPP手术,三组术中出血量、术后住院时间、伤口或补片感染与慢性疼痛比较,差异无统计学意义(P>0.05);B、C两组的手术时间长于A组,血清肿发生率低于A组,差异有统计学意义(P<0.05);A组、C组异物牵拉感发生率低于B组,差异有统计学意义(P<0.05);B组、C组住院费用低于A组,差异有统计学意义(P<0.05)。结论 腹股沟直疝TAPP术中采取单纯连续缝合法与环形缝合悬吊法处理假疝囊均有改善病情的效果,但在经济性、术后效果等方面,环形缝合悬吊法更能使病人获益。

腹腔镜经腹腹膜前疝修补术对青年患者睾丸血管及生殖功能的影响

目的:探讨腹腔镜经腹腹膜前疝修补术对青年患者睾丸血管及生殖功能的影响。方法:纳入2018年6月至2020年1月行腹腔镜经腹腹膜前疝修补术的32例男性患者作为研究对象,分别于术前1 d及术后1个月、6个月进行超声检查,测量患者双侧精索静脉内径、睾丸体积、睾丸动脉内径、睾丸动脉收缩期峰值血流速度等指标,并常规检测外周血清睾酮浓度、国际勃起功能指数。结果:32例手术均获成功。术后1个月,患侧精索静脉管径较术前明显增粗(P<0.05);术后6个月,测量管径与术前相比差异无统计学意义(P>0.05)。术后1个月、6个月,患者外周血清睾酮浓度、国际勃起功能指数、睾丸体积、睾丸动脉内径、睾丸动脉收缩期峰值血流速度与术前相比差异无统计学意义(P>0.05)。结论:腹腔镜经腹腹膜前疝修补术后早期可影响患侧精索静脉内径,术后6个月即可恢复正常,治疗青年腹股沟疝是安全、可靠的,不会影响患者的睾丸血管及生殖功能。

腹腔镜下经腹腔腹膜前疝修补术治疗嵌顿性股疝的临床效果研究

目的:探讨腹腔镜下经腹腔腹膜前疝修补术(TAPP)在治疗嵌顿性股疝方面的安全性及有效性。方法:回顾分析2017年4月—2021年12月天津中医药大学第一附属医院收治的30例嵌顿性股疝患者的临床资料,根据手术方式分为腹腔镜组17例,开放组13例,比较两组患者的手术情况、住院时间、并发症及随访结果等。结果:腹腔镜组手术时间[(71.35±10.48)min vs(86.90±12.54)min,P=0.010]、术中出血量[(17.06±3.40)m L vs(33.69±6.55)m L,P<0.001]、住院天数少于开放组[(5.90±1.30)d vs(8.23±9.93)d,P<0.001],术后疼痛评分低于开放组[(1.12±0.33)vs(2.09±0.70),P<0.001],术后排气时间短于开放组[(14.82±4.20)h vs(21.64±3.17)h,P<0.001],差异均有统计学意义;两组术后并发症无统计差异,术后随访1年,两组患者均未见复发。结论:TAPP手术治疗嵌顿性股疝是安全有效的,具有减少手术时间及出血,促进患者康复的优势。

腹腔镜下经腹腹膜前间隙疝修补术治疗老年嵌顿性腹股沟疝患者的效果

目的:观察腹腔镜下经腹腹膜前间隙疝修补术治疗老年嵌顿性腹股沟疝患者的效果。方法:选取2020年1月至2022年12月该院收治的121例老年嵌顿性腹股沟疝患者进行前瞻性研究,根据随机数字表法将其分为对照组60例和观察组61例。对照组采用无张力疝修补术治疗,观察组采用腹腔镜下经腹腹膜前间隙疝修补术治疗,比较两组围手术指标水平、手术前后疼痛程度[视觉模拟评分法(VAS)]评分、创伤应激反应指标[前列腺素E_(2)(PGE_(2))、促肾上腺皮质激素释放激素(CRH)、促肾上腺皮质激素(ACTH)]水平和术后1周并发症发生率。结果:观察组手术时间长于对照组,肛门排气时间和下床活动时间均短于对照组,术中出血量少于对照组,差异有统计学意义(P<0.05);术后,观察组VAS评分低于对照组,差异有统计学意义(P<0.05);术后,两组PGE_(2)、CRH、ACTH水平均高于术前,但观察组低于对照组,差异有统计学意义(P<0.05);两组术后并发症发生率比较,差异无统计学意义(P>0.05)。结论:腹腔镜下经腹腹膜前间隙疝修补术治疗老年嵌顿性腹股沟疝患者可改善围手术指标水平,降低VAS评分和创伤应激反应指标水平,效果优于无张力疝修补术治疗。

开放腹膜前修补术治疗成人小型脐疝的临床效果观察

目的观察开放腹膜前修补术治疗成人小型脐疝的临床效果。方法回顾性分析2018年1月至2022年10月济宁医学院附属金乡医院收治的88例小型脐疝患者的临床资料,根据手术方式将其分为观察组(采用开放腹膜前修补术,n=42)和对照组(采用传统缝合修补术,n=46)。比较两组手术时间、术中出血量、术后视觉模拟量表(VAS)评分、切口愈合等级、住院时间,以及术后血清肿、局部感觉异常、慢性疼痛和复发情况。结果88例患者均顺利完成手术。观察组手术时间显著长于对照组[(51.24±12.64)minvs(42.04±11.88)min;t=3.419,P=0.001]。两组术后VAS评分均呈下降趋势(P<0.05)。在术后第1天和第2天,观察组VAS评分显著低于对照组(P<0.05),两组VAS评分在术后第3天比较差异无统计学意义(P>0.05)。两组术中出血量、切口愈合等级,以及术后血清肿、慢性疼痛、局部感觉异常发生率比较差异无统计学意义(P>0.05)。观察组和对照组中位随访时间分别为19个月和17个月,随访期间观察组无复发,对照组有5例复发,两组复发情况比较差异有统计学意义(log-rank检验:χ_(2)=4.833,P=0.027)。结论开放腹膜前修补术治疗成人小型脐疝安全有效,值得临床推荐。

腹腔镜完全腹膜外腹股沟疝修补术(TEP)中不同补片固定方法的优势评价

目的探讨成人腹股沟疝接受腹腔镜完全腹膜外腹股沟疝修补术(Total Extraperitoneal Approach for Hernia Repair,TEP)中,选择不同补片固定方法的优劣比较。方法选取200例成人腹股沟疝患者,研究对象取自2019年1月到2022年12月。按不同的补片固定方法分组,100例术中采用生物胶固定补片的治疗对象纳入对照组,另外100例术中采用不固定补片的治疗对象纳入观察组,比较两组手术情况、视觉模拟疼痛(VAS)评分、炎性因子及并发症情况。结果两组的术中出血量、术后正常活动及住院时间无统计学意义(t=1.095,0.115,0.631;P>0.05);观察组术后12h的VAS评分(3.42±1.13)分、24h的VAS评分(2.38±0.75)分、48 h的VAS评分(1.48±0.42)分均低于对照组(t=6.560,9.794,12.551;P<0.05)。观察组术后CRP水平(18.27±5.03)mg/L、IL-6水平(18.72±5.23)ng/L低于对照组(t=3.891,7.833;P<0.05)。观察组术后并发症发生率5.00%更低(χ^(2)=6.437;P<0.05)。结论TEP术中不固定补片具有术后疼痛轻、炎性因子水平低及并发症少等应用优势,临床价值显著。