The objective was to study epidemiological and therapeutic aspects of the inguinal hernia according to the technique of Shouldice. Methodology: we realized a retrospective study, concerning the patients operated for i...The objective was to study epidemiological and therapeutic aspects of the inguinal hernia according to the technique of Shouldice. Methodology: we realized a retrospective study, concerning the patients operated for inguinal hernia according to the technique of Shouldice in the service of general surgery of the hospital Sominé Dolo of Mopti, Mali. All the patients operated during the period of study for inguinal hernia according to the technique of Shouldice were included. The patients operated for hernia by other technique than that of Shouldice were not included. Results: The study has been realized in the service of general surgery of the hospital Sominé Dolo of Mopti (Mali). It was about a retrospective study which concerned 25 years from January, 1987 till December, 2012. 675 patients operated according to the technique of Shouldice were registered. The average age was of 49 years +/−17.7. There were 90.7% (612) men. The sex-ratio is 9.7. The farmers, the housewives and the workers represented 51.1% (115). In 75.2% (508) the patients consulted for inguinal tumefaction. In operating meadow, the hernia was complicated to 246 (36.4%) patients among whom 72 cases were of recurrence. The hernia constriction was the main complication operating meadow 58.5% (48/82). The operating suites in one year were simple at 94.2% (636) of the patients;they were marked by 24 cases of recurrence, 12 cases of neuralgia, 6 cases of testicular atrophy, and 3 cases of keloid. Conclusion: The technique of Shouldice is the technique of choice for the cure of the inguinal hernia in developing countries because of the good result and its little expensive cost with compared with the other techniques using medical devices.展开更多
BACKGROUND Inguinal hernias are common after surgery.Tension-free repair is widely accepted as the main method for managing inguinal hernias.Adequate exposure,coverage,and repair of the myopectineal orifice(MPO)are ne...BACKGROUND Inguinal hernias are common after surgery.Tension-free repair is widely accepted as the main method for managing inguinal hernias.Adequate exposure,coverage,and repair of the myopectineal orifice(MPO)are necessary.However,due to differences in race and sex,people’s body shapes vary.According to European guidelines,the patch should measure 10 cm×15 cm.If any part of the MPO is dissected,injury to the nerves,vascular network,or organs may occur during surgery,thereby leading to inguinal discomfort,pain,and seroma formation after surgery.Therefore,accurate localization and measurement of the boundary of the MPO are crucial for selecting the optimal patch for inguinal hernia repair.AIM To compare the size of the MPO measured on three-dimensional multislice spiral computed tomography(CT)with that measured via laparoscopy and explore the relevant factors influencing the size of the MPO.METHODS Clinical data from 74 patients who underwent laparoscopic tension-free inguinal hernia repair at the General Surgery Department of the First Affiliated Hospital of Anhui University of Science and Technology between September 2022 and July 2024 were collected and analyzed retrospectively.Transabdominal preperitoneal was performed.Sixty-four males and 10 females,with an average age of 58.30±12.32 years,were included.The clinical data of the patients were collected.The boundary of the MPO was measured on three-dimensional CT images before surgery and then again during transabdominal preperitoneal.All the preoperative and intraoperative data were analyzed via paired t-tests.A t-test was used for comparisons of age,body mass index,and sex between the groups.In the comparative analysis,a P value less than 0.05 indicated a significant difference.RESULTS The boundaries of the MPO on 3-dimensional CT images measured 7.05±0.47 cm and 6.27±0.61 cm,and the area of the MPO was 19.54±3.33 cm^(2).The boundaries of the MPO during surgery were 7.18±0.51 cm and 6.17±0.40 cm.The errors were not statistically significant.However,the intraoperative BD(the width of the MPO,P=0.024,P<0.05)and preoperative AC(the length of the MPO,P=0.045,P<0.05)significantly differed according to sex.The AC and BD measurements before and during surgery were not significantly different according to age,body mass index,hernia side or hernia type(P>0.05).CONCLUSION The application of this technology can aid in determining the most appropriate dissection range and patch size.展开更多
BACKGROUND Currently,very few studies have examined the analgesic effectiveness and safety of dexmedetomidine-assisted intravenous-inhalation combined general anesthesia in laparoscopic minimally invasive surgery for ...BACKGROUND Currently,very few studies have examined the analgesic effectiveness and safety of dexmedetomidine-assisted intravenous-inhalation combined general anesthesia in laparoscopic minimally invasive surgery for inguinal hernia.AIM To investigate the analgesic effect and safety of dexmedetomidine-assisted intravenous-inhalation combined general anesthesia in laparoscopic minimally invasive surgery for inguinal hernia.METHODS In this retrospective study,94 patients scheduled for laparoscopic minimally invasive surgery for inguinal hernia,admitted to Yiwu Central Hospital between May 2022 and May 2023,were divided into a control group(inhalation combined general anesthesia)and a treatment group(dexmedetomidine-assisted intrave-nous-inhalation combined general anesthesia).Perioperative indicators,analgesic effect,preoperative and postoperative 24-hours blood pressure(BP)and heart rate(HR),stress indicators,immune function levels,and adverse reactions were com-pared between the two groups.RESULTS Baseline data,including age,hernia location,place of residence,weight,monthly income,education level,and underlying diseases,were not significantly different between the two groups,indicating comparability(P>0.05).No significant difference was found in operation time and anesthesia time between the two groups(P>0.05).However,the treatment group exhibited a shorter postoperative urinary catheter removal time and hospital stay than the control group(P<0.05).Preoperatively,no significant differences were found in the visual analog scale(VAS)scores between the two groups(P>0.05).However,at 12,18,and 24 hours postoper-atively,the treatment group had significantly lower VAS scores than the control group(P<0.05).Although no significant differences in preoperative hemodynamic indicators were found between the two groups(P>0.05),both groups experienced some extent of changes in postoperative HR,diastolic BP(DBP),and systolic BP(SBP).Nevertheless,the treatment group showed smaller changes in HR,DBP,and SBP than the control group(P<0.05).Preoperative immune function indicators showed no significant differences between the two groups(P>0.05).However,postoperatively,the treatment group demonstrated higher levels of CD3+,CD4+,and CD4+/CD8+and lower levels of CD8+than the control group(P<0.05).The rates of adverse reactions were 6.38%and 23.40%in the treatment and control groups,respectively,revealing a significant difference(χ2=5.371,P=0.020).CONCLUSION Dexmedetomidine-assisted intravenous-inhalation combined general anesthesia can promote early recovery of patients undergoing laparoscopic minimally invasive surgery for inguinal hernia.It ensures stable blood flow,improves postoperative analgesic effects,reduces postoperative pain intensity,alleviates stress response,improves immune function,facilitates anesthesia recovery,and enhances safety.展开更多
This study aimed to explore the application effect of the medical and nursing integration working mode in children with inguinal hernia undergoing laparoscopic surgery and to provide a basis for its clinical promotion...This study aimed to explore the application effect of the medical and nursing integration working mode in children with inguinal hernia undergoing laparoscopic surgery and to provide a basis for its clinical promotion.A total of 70 children with inguinal hernia admitted to our hospital from July 2023 to June 2024 and treated with laparoscopic surgery were selected as study subjects and randomly divided into an observation group and a control group,with 35 cases in each.Both groups received routine nursing care,while the observation group additionally adopted the integrated medical and nursing working mode,including systematic health education,psychological interventions,and postoperative follow-up from admission to discharge.The anxiety and depression scores of the two groups before and after surgery,medical compliance index,and incidence of complications during hospitalization were compared.Results showed that the preoperative anxiety scores of the observation and control groups were(14.01±1.07)and(14.62±2.31),respectively,with no statistically significant difference(P>0.05);however,postoperative anxiety scores were significantly lower in the observation group(4.01±0.77)compared to the control group(6.62±0.31)(P<0.05).Similarly,preoperative depression scores were(15.11±1.22)in the observation group and(15.41±2.01)in the control group(P>0.05),but postoperative depression scores were significantly reduced in the observation group(4.24±0.61)compared to the control group(7.12±0.54)(P<0.05).After intervention,the medical compliance behavior index in the observation group was(83.31±5.92),significantly higher than(75.34±6.73)in the control group(P<0.05).Regarding postoperative complications,only 1 case(2.86%)occurred in the observation group,while 8 cases(22.86%)were reported in the control group,showing a statistically significant difference(P<0.05).In conclusion,the medical and nursing integration working mode effectively improves the perioperative psychological state of children,enhances medical compliance,reduces postoperative complications,and is worthy of widespread clinical application.展开更多
BACKGROUND Laparoscopic surgery,with the advantage of less trauma,has been predominantly performed to treat pediatric inguinal hernia.However,the traditional three-port laparoscopic surgery remains extremely traumatic...BACKGROUND Laparoscopic surgery,with the advantage of less trauma,has been predominantly performed to treat pediatric inguinal hernia.However,the traditional three-port laparoscopic surgery remains extremely traumatic for children,whereas singleport laparoscopic surgery causes less damage to children than traditional laparoscopy.However,single-port laparoscopic surgery is more challenging;thus,studies on the effect of its application in pediatric inguinal hernia remain relatively limited.AIM To analyze the association of single-incision laparoscopic herniorrhaphy needle treatment with surgical outcomes,postoperative complications,and serum inflammation in pediatric inguinal hernia.METHODS This retrospective study included 113 pediatric patients with inguinal hernia who underwent surgery at the Children’s Hospital,Capital Institute of Pediatrics,from April 2022 to May 2023.Participants were categorized into the observation group(single-incision laparoscopic herniorrhaphy needle,n=60)and the control group(two-port laparoscopic surgery,n=53).Comparative analyses involved surgical duration,intraoperative blood loss,and length of hospital stay.C-reactive protein(CRP)and white blood cell count(WBC)levels were measured preoperatively and 24 hours postoperatively.Postoperative pain was evaluated with the face,legs,activity,cry,and Consolability scale.Further,the incidence of complications,recurrence,and reoperation rates was assessed.Logistic regression was employed to determine independent risk factors related to poor prognosis.RESULTS The observation group demonstrated significantly reduced intraoperative blood loss and shorter hospitalization compared to the control group(P<0.05).Both groups demonstrated increased CRP and WBC levels postoperatively,but the observation group exhibited significantly lower levels(P<0.05).Further,pain scores at 24 hours postoperatively were significantly lower in the observation group(P<0.05).Additionally,the observation group experienced fewer adverse events,recurrence rates,and reoperations compared to the control group(P<0.05).Logistic regression analysis determined increased postoperative stress markers and surgical technique as independent predictors of recurrence(P<0.05).CONCLUSION Single-incision laparoscopic herniorrhaphy needle treatment for pediatric inguinal hernia exhibits significant efficacy,effectively reduces postoperative complications,ensures a more concealed surgical incision,and promotes faster postoperative recovery than conventional two-port laparoscopy.This approach merits wider application.展开更多
Objective:To explore the effect of medical and nursing integration mode on the nursing care of patients with inguinal hernia treated by tension-free repair.Methods:A total of 76 cases of inguinal hernia patients admit...Objective:To explore the effect of medical and nursing integration mode on the nursing care of patients with inguinal hernia treated by tension-free repair.Methods:A total of 76 cases of inguinal hernia patients admitted to the hospital from September 2023 to August 2024 were selected as study subjects.They were divided into 38 cases each in the control group and the observation group by using the random number table method.The patients in the control group were cared for by the traditional postoperative care mode and the patients in the observation group were given additional medical and nursing care based on the control group,and were observed and analyzed for pain relief,infection,hospital stay,and hospital costs.Results:The VAS score of patients in the observation group was(7.91±2.21)at 1d postoperation and(11.04±3.24)at 1d postoperation in the control group,which was significantly lower than that of the control group,with a statistically significant difference(P<0.05),and the VAS score of the patients at 6 months postoperation was(4.82±1.81),which was not statistically significant when compared with that of the control patients(4.79±1.45),which was not statistically different from those of the control group(P>0.05);3 cases of infection occurred in the at 3d,accounting for the total number of observation group postoperative patients(7.89%),and compared with control group with postoperative 5 cases of infection occurred in the 3 days,accounting for of the total number of patients(13.16%),the postoperative infection rate of the patients in the observation group was significantly reduced,and the difference was statistically significant(P<0.05).The number of hospitalization days as well as the hospitalization costs of the observation group were significantly lower than those of the control group,and the difference was statistically significant(P<0.05).Conclusion:The integrated model of medical care has significant advantages in the care of patients with inguinal hernia treated with tension-free repair,which can effectively alleviate early postoperative pain,reduce the rate of infection,shorten the length of hospital stay,and reduce the cost of hospitalization.展开更多
BACKGROUND The most common causes of scrotal enlargement in patients include primary tumor of the scrotum,inflammation,hydrocele of the tunica vaginalis,and indirect inguinal hernia;scrotal enlargement caused by exter...BACKGROUND The most common causes of scrotal enlargement in patients include primary tumor of the scrotum,inflammation,hydrocele of the tunica vaginalis,and indirect inguinal hernia;scrotal enlargement caused by external tumors of the scrotum is rare.The patient had both a greater omentum tumor and an inguinal hernia,and the tumor protruded into the scrotum through the hernia sac,which is even rarer.Moreover,omental tumors are mostly metastatic,and primary omental fibroma is rare.CASE SUMMARY Here,we report a rare case of a 25-year-old young man with scrotal enlargement and pain for 3 months.Preoperative examination and multidisciplinary discu-ssions considered intra-abdominal tumor displacement and inguinal hernia,and intraoperative exploration confirmed that the greater omentum tumor protruded into the scrotum.Therefore,tumor resection and tension-free inguinal hernia repair were performed.The final diagnosis was benign fibroma of the greater omentum accompanied by an indirect inguinal hernia.CONCLUSION This unusual presentation of a common inguinal hernia disease illustrates the necessity of performing detailed history taking,physical examination,and imaging before surgery.展开更多
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 ...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.展开更多
Inguinal hernia in children is a congenital pathology in children linked to the persistence of the peritoneo-vaginal canal in children and the NüCK canal in girls;persisting into adulthood. This work aimed to stu...Inguinal hernia in children is a congenital pathology in children linked to the persistence of the peritoneo-vaginal canal in children and the NüCK canal in girls;persisting into adulthood. This work aimed to study inguinal hernia in children in the general surgery department of the Reference Health Center of Commune I of the Bamako District;to determine the frequency of inguinal hernia;describe the epidemiological, clinical and therapeutic aspects of inguinal hernias and in order to evaluate the cost of treatment. This was a prospective study from April 2017 to March 2018 during which 60 children with an inguinal hernia were collected. Inguinal hernias in children represented 9.23% of patients operated on in the department. The average age was 59.23 months with extremes of one month and 180 months and a standard deviation of 49.23 years. The male sex was dominant with a sex ratio equal to 9:1. The notion of prematurity was found in 11.7% and was associated with a testicle not in place in 1.7% of cases. 41.7% of our patients were referred by a doctor and 66.7% of patients presented with painless, intermittent inguino-scrotal swelling (83.3% of cases). The hernia was discovered before one week of life in 50% of cases. Inguinal swelling was absent in 11.7% but observed intraoperatively. The inguinal hernia was unilateral in 91.7% of cases and 70% of hernias were discovered by the parents during pushing efforts. The inguinal hernia was located on the right in 61.7% of cases. The hernia swelling was soft, painless, impulsive and reducible in 78.3% of cases. The swelling was inguino-scrotal in 58.3% of cases. The hernia was simple in 95% of patients and hernial strangulation was observed in 3 cases or 5% of cases. 98.3% of patients were ASA I. The treatment was carried out openly in all our patients including closure of the vaginal peritoneal canal in 95% of cases under general anesthesia in 98.3% of cases. The morbidity rate was 8.4% (surgical site infection: 6.7% of cases and hematoma: 1.7%). The immediate consequences were simple in 96.6% of cases. No cases of recurrence occurred during the 6 months after the intervention. The average cost of care was estimated at 69,743 FCFA.展开更多
Objective:A comprehensive meta-analysis based on the latest randomized controlled trials(RCTs)was conducted to investigate the effects of transcutaneous electrical nerve stimulation(TENS)on patients undergoing treatme...Objective:A comprehensive meta-analysis based on the latest randomized controlled trials(RCTs)was conducted to investigate the effects of transcutaneous electrical nerve stimulation(TENS)on patients undergoing treatment after inguinal hernia surgery.Methods:A detailed search of Embase,PubMed,Web of Science,and the Cochrane Library was performed for RCTs investigating the use of TENS during inguinal hernia surgery up to September 28,2021.The Cochrane tool was applied to assess the risk of bias in the included studies.Results:Seven eligible RCTs with a total of 379 cases were included.The meta-analysis showed a mean difference(MD)in VAS of-1.61[95%CI:-2.20-1.02,P<0.00001]at 2 hours post-operation,VAS MD=-1.33 at 4 hours post-operation[95%CI:-2.84-0.18,P=0.09],VAS MD=-2.36 at 8 hours post-operation[95%CI:-4.04-0.69,P=0.006],and VAS MD=-1.75 at 24 hours post-operation[95%CI:-2.64-0.85,P=0.0001].The cortisol level MD at 24 hours post-operation was-52.56[95%CI:-168.8-63.76,P=0.38].Conclusion:TENS significantly reduces postoperative pain following inguinal hernia surgery and promotes patient recovery.TENS is recommended for patients undergoing inguinal hernia surgery.However,further high-quality studies are needed to confirm additional effects.展开更多
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 fr...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.展开更多
We present a case report of laparoscopic herniorrhaphy in an infant with ovarian prolapse. Using this case study, we demonstrate the role of the ovarian ligamentous apparatus. A structure appearing like the male guber...We present a case report of laparoscopic herniorrhaphy in an infant with ovarian prolapse. Using this case study, we demonstrate the role of the ovarian ligamentous apparatus. A structure appearing like the male gubernaculum was identified. The anatomical and functional role of this “gubernaculum” will be the subject of discussion. Further detailed laparoscopic examinations are indicated to better understand the ligamentous anatomy of ovarian prolapse.展开更多
Objective: To study the diagnostic and therapeutic aspects of uncomplicated inguinal hernias in the general surgery unit of CSRéf CII. Method: This was a prospective, descriptive, single-centre study from 1 Janua...Objective: To study the diagnostic and therapeutic aspects of uncomplicated inguinal hernias in the general surgery unit of CSRéf CII. Method: This was a prospective, descriptive, single-centre study from 1 January 2016 to 31 December 2016 of 84 patients operated on for inguinal hernias in the general surgery unit of CSRéf CII. Results: Inguinal hernia accounted for 8% of surgical consultations and hernia repair accounted for 30.22% of surgical procedures. Hernia repair accounted for 30.22% of surgical procedures. The male sex was the most represented with a ratio of 7.40. The average age of our patients was 43.19 years. Recurrence occurred in 10% of cases. The right side was most affected in 71.43% of cases, 19.05% on the left side in;it was bilateral in 09.52%. Local anaesthesia was used in 67.86% of our patients, general anaesthesia in 13.09% of cases and locoregional anaesthesia in 19.05% of cases. The hernia was external oblique in 75% of cases. Shouldice’s technique was the most used with 88%;Bassini’s technique was used in 7% and Mac Vay’s in 5% of cases. The postoperative course was simple in 96.43% of cases, with an early postoperative morbidity rate of 3.57%, one case of wall abscess and two cases of parietal haematoma. No deaths were observed during our study. Conclusion: The new methods of tension-free cure should be used more and more by our users in our facilities.展开更多
Groin hernias include indirect inguinal, direct inguinal, and femoral hernias. Obturator and supravesical hernias appear very close to the groin. High-quality repairs are required for groin hernias. The concept of &qu...Groin hernias include indirect inguinal, direct inguinal, and femoral hernias. Obturator and supravesical hernias appear very close to the groin. High-quality repairs are required for groin hernias. The concept of "tension-free repair" is generally accepted, and surgical repairs with mesh are categorized as "hernioplasties". Surgeons should have good knowledge of the relevant anatomy. Physicians generally focus on the preperitoneal space, myopectineal orifice, topographic nerves, and regional vessels. Currently, laparoscopic surgery has therapeutic potential in the surgical setting for hernioplasty, with laparoscopic transabdominal preperitoneal(TAPP) repair appearing to be a powerful tool for use in adult hernia patients. TAPP offers the advantages of accurate diagnoses, repair of bilateral and recurrent hernias, less postoperative pain, early recovery allowing work and activities, tension-free repair of the preperitoneal(posterior) space, ability to cover obturator hernias, and avoidance of potential injury to the spermatic cord. The disadvantages of TAPP are the need for general anesthesia, adhering to a learning curve, higher cost, unexpected complications related to abdominal organs, adhesion to the mesh, unexpected injuries to vessels, prolonged operative time, and as-yet-unknown long-term outcomes. Both technical skill and anatomical familiarity are important for safe, reliable surgery. With increasing awareness of the importance of anatomy during TAPP repair, we address the skills and pitfalls during laparoscopic TAPP repair in adult patients using illustrations and schemas. We also address debatable points on this subject.展开更多
AIM To study the utility of single-incision totally extraperitoneal inguinal hernia repair with intraperitoneal inspection.METHODS A 2 cm transverse skin incision was made in the umbilicus, extending to the intraperit...AIM To study the utility of single-incision totally extraperitoneal inguinal hernia repair with intraperitoneal inspection.METHODS A 2 cm transverse skin incision was made in the umbilicus, extending to the intraperitoneal cavity. Carbon dioxide was insufflated followed by insertion of laparoscope to observe the intraperitoneal cavity. The type of hernia was diagnosed and whether there was the presence of intestinal incarceration was confirmed. When an intestinal incarceration in the hernia sac was found, the forceps were inserted through the incision site and the intestine was returned to the intraperitoneal cavity without increasing the number of trocars. Once the peritoneum was closed, totally extraperitoneal inguinal hernia repair was performed, and finally, intraperitoneal observation was performed to reconfirm the repair.RESULTS Of the 75 hernias treated, 58 were on one side, 17 were on both sides, and 10 were recurrences. The respective median operation times for these 3 groups of patients were 100 min(range, 66 to 168), 136 min(range, 114 to 165), and 125 min(range, 108 to 156), with median bleeding amounts of 5 g(range, 1 to 26), 3 g(range, 1 to 52), and 5 g(range, 1 to 26), respectively. Intraperitoneal observation showed hernia on the opposite side in 2 cases, intestinal incarceration in 3 cases, omental adhesion into the hernia sac in 2 cases, severe postoperative intraperitoneal adhesions in 2 cases, and bladder protrusion in 1 case. There was only 1 case of recurrence.CONCLUSION Single-incision totally extraperitoneal inguinal hernia repair with intraperitoneal inspection makes hernia repairs safer and reducing postoperative complications. The technique also has excellent cosmetic outcomes.展开更多
BACKGROUND Inguinal hernia is a common clinical manifestation in children with a low selfhealing rate.AIM To determine the effect of laparoscopic surgery on indirect inguinal hernia and the risk factors for postoperat...BACKGROUND Inguinal hernia is a common clinical manifestation in children with a low selfhealing rate.AIM To determine the effect of laparoscopic surgery on indirect inguinal hernia and the risk factors for postoperative recurrence and to provide a reference for the clinical treatment and prevention of recurrence.METHODS We selected 360 children who underwent laparoscopic high ligation in our hospital as the laparoscopic group and 120 patients treated for inguinal hernia with conventional surgery as the control group.The operation time,blood loss,incision length,hospitalization time,total hospitalization cost and surgical complications were compared between the two groups.According to telephone follow-up or return visits,the children who had recurrence within 2 years after the operation in the laparoscopic group were analyzed,and the laparoscopic high ligation hernia sac level was analyzed by the logistic multifactor method.Ligation was used to treat recurrence in children with inguinal hernia.RESULTS The operation time,blood loss,length of incision,and length of hospital stay in the laparoscopic group were lower than those in the control group(P<0.05).The total hospitalization cost in the laparoscopic group was higher than that in the control group(P<0.05).The operative complication rate was 1.67%lower than that in the control group(12.50%)(P<0.05).In 360 children with laparoscopic high ligation of the hernia sac,14 patients had recurrence within 2 years after surgery.After analysis,14 cases in the recurrence group did not recur.The preoperative incarceration rate,inner ring diameter,ligature use and age difference were statistically significant(P<0.05).According to logistic regression multivariate analysis,an inner ring diameter≥1.0 cm,the use of an absorbable ligature line and age>3 years increased the risk of postoperative recurrence in children with inguinal hernia after laparoscopic high ligation of the hernia sac(P<0.05).CONCLUSION Laparoscopic surgery for indirect inguinal hernia in children has the advantages of low trauma and a rapid postoperative recovery.An inner ring diameter≥1.0 cm,the use of absorbable ligature,and age>3 years may increase the risk of recurrence after laparoscopic high ligation of the hernia sac.展开更多
GIANT hydronephrosis is a rare urological entity. It was first defined as the presence of more than 1000 mL of fluid in the collecting sys-tem.1 That disease is seen more often in males
BACKGROUND Mesh plug(MP)erosion into the intra-abdominal organs is a rare but serious long-term complication after inguinal hernia repair(IHR),and may lead to aggravation of symptoms if not treated promptly.It is diff...BACKGROUND Mesh plug(MP)erosion into the intra-abdominal organs is a rare but serious long-term complication after inguinal hernia repair(IHR),and may lead to aggravation of symptoms if not treated promptly.It is difficult to diagnose MP erosion as there are no obvious specific clinical manifestations,and surgery is often needed for confirmation.In recent years,with the increased understanding of postoperative complications,MP eroding into the intra-abdominal organs has been a cause for concern among surgeons.CASE SUMMARY A 50-year-old man was referred to the Department of General Surgery with the complaint of abdominal pain in the right lower quadrant for 2 d.He had a surgical history of right open IHR and partial thyroidectomy performed 20 years and 15 years ago,respectively.Computed tomography revealed a circinate highdensity image with short segmental thickening of the ileum stuck to the abdominal wall,and no evidence of recurrent inguinal hernia.Laparoscopic abdominal exploration confirmed adhesion of the middle segmental portion of the ileal loop to the right inguinal abdominal wall;the rest of the small intestine was normal.Further exploration revealed migration of the polypropylene MP into the intraperitoneal cavity and formation of granulation tissue around the plug,which eroded the ileum.Partial resection of the ileum,including the MP and end-to-side anastomosis with an anastomat,was performed.CONCLUSION Surgeons should aim to improve their ability to predict patients at high risk for MP erosion after IHR.展开更多
We report a case of surgically proved left-sided torsion of the greater omentum that caused secondary by untreated inguinal hernia. Case A 36-year-old man presented to our hospital with abdominal pain. He had been dia...We report a case of surgically proved left-sided torsion of the greater omentum that caused secondary by untreated inguinal hernia. Case A 36-year-old man presented to our hospital with abdominal pain. He had been diagnosed with a left inguinal hernia, but he had not received any treatments. Contrast-enhanced computed tomography （CT） of the abdomen showed a large fat density mass below the Sigmoid colon and left inguinal hernia with incarcerated fat. Exploratory laparotomy revealed torsion of the greater omentum with small bloody ascites. The greater omentum was twisted into one and a half circles and entered into a left inguinal hernia. An omentectomy with a repair of left inguinal hernia was performed. A resected omentum was submitted for pathological examination, which showed hemorrhagic infarction. Omental torsion is a rare cause of acute abdominal pain but should be included in the differential diagnoses of acute abdomen, especially in patients with untreated inguinal hernia.展开更多
BACKGROUND Primary omental tumors are uncommon,and omental fibromas account for 2%of these tumors.Due to the low incidence of omental fibromas and the limited relevant literature,it is challenging for clinicians to ma...BACKGROUND Primary omental tumors are uncommon,and omental fibromas account for 2%of these tumors.Due to the low incidence of omental fibromas and the limited relevant literature,it is challenging for clinicians to make an accurate diagnosis of this condition,especially before surgery.CASE SUMMARY A 30-year-old man was admitted to the hospital because of a left epididymal mass with vague discomfort for more than 1 mo.A physical examination was performed,and the findings showed that the epididymal mass may have entered the abdominal cavity.Pelvic computed tomography was performed in our hospital and revealed a left inguinal hernia with a mass in the hernial contents,and no masses were found in the left epididymis.A traditional inguinal hernia incision was made.Intraoperative hernia contents were found to be of the greater omentum,and a 2.5 cm-diameter mass was found at the distal end of the greater omentum.The scrotum and epididymis did not exhibit other masses.Then,the mass of the greater omentum was excised.Intraoperative frozen pathological examination suggested a spindle cell tumor.The postoperative pathological examination suggested that the mass was an omental angiofibroma.Postoperatively,the patient recovered well and was discharged.Outpatient re-examinations were performed at 1 mo and half a year after the operation and showed no obvious abnormalities.CONCLUSION Due to the low morbidity rate associated with and latent nature of omental tumors,these tumors are difficult to diagnose preoperatively;thorough medical history taking,detailed physical examinations,and necessary imaging auxiliary examinations can help clinicians diagnose and treat these cases.展开更多
文摘The objective was to study epidemiological and therapeutic aspects of the inguinal hernia according to the technique of Shouldice. Methodology: we realized a retrospective study, concerning the patients operated for inguinal hernia according to the technique of Shouldice in the service of general surgery of the hospital Sominé Dolo of Mopti, Mali. All the patients operated during the period of study for inguinal hernia according to the technique of Shouldice were included. The patients operated for hernia by other technique than that of Shouldice were not included. Results: The study has been realized in the service of general surgery of the hospital Sominé Dolo of Mopti (Mali). It was about a retrospective study which concerned 25 years from January, 1987 till December, 2012. 675 patients operated according to the technique of Shouldice were registered. The average age was of 49 years +/−17.7. There were 90.7% (612) men. The sex-ratio is 9.7. The farmers, the housewives and the workers represented 51.1% (115). In 75.2% (508) the patients consulted for inguinal tumefaction. In operating meadow, the hernia was complicated to 246 (36.4%) patients among whom 72 cases were of recurrence. The hernia constriction was the main complication operating meadow 58.5% (48/82). The operating suites in one year were simple at 94.2% (636) of the patients;they were marked by 24 cases of recurrence, 12 cases of neuralgia, 6 cases of testicular atrophy, and 3 cases of keloid. Conclusion: The technique of Shouldice is the technique of choice for the cure of the inguinal hernia in developing countries because of the good result and its little expensive cost with compared with the other techniques using medical devices.
基金Supported by the 2022 Provincial Quality Engineering Project for Higher Education Institutions,No.2022sx031the 2023 Provincial Quality Engineering Project for Higher Education Institutions,No.2023jyxm1071.
文摘BACKGROUND Inguinal hernias are common after surgery.Tension-free repair is widely accepted as the main method for managing inguinal hernias.Adequate exposure,coverage,and repair of the myopectineal orifice(MPO)are necessary.However,due to differences in race and sex,people’s body shapes vary.According to European guidelines,the patch should measure 10 cm×15 cm.If any part of the MPO is dissected,injury to the nerves,vascular network,or organs may occur during surgery,thereby leading to inguinal discomfort,pain,and seroma formation after surgery.Therefore,accurate localization and measurement of the boundary of the MPO are crucial for selecting the optimal patch for inguinal hernia repair.AIM To compare the size of the MPO measured on three-dimensional multislice spiral computed tomography(CT)with that measured via laparoscopy and explore the relevant factors influencing the size of the MPO.METHODS Clinical data from 74 patients who underwent laparoscopic tension-free inguinal hernia repair at the General Surgery Department of the First Affiliated Hospital of Anhui University of Science and Technology between September 2022 and July 2024 were collected and analyzed retrospectively.Transabdominal preperitoneal was performed.Sixty-four males and 10 females,with an average age of 58.30±12.32 years,were included.The clinical data of the patients were collected.The boundary of the MPO was measured on three-dimensional CT images before surgery and then again during transabdominal preperitoneal.All the preoperative and intraoperative data were analyzed via paired t-tests.A t-test was used for comparisons of age,body mass index,and sex between the groups.In the comparative analysis,a P value less than 0.05 indicated a significant difference.RESULTS The boundaries of the MPO on 3-dimensional CT images measured 7.05±0.47 cm and 6.27±0.61 cm,and the area of the MPO was 19.54±3.33 cm^(2).The boundaries of the MPO during surgery were 7.18±0.51 cm and 6.17±0.40 cm.The errors were not statistically significant.However,the intraoperative BD(the width of the MPO,P=0.024,P<0.05)and preoperative AC(the length of the MPO,P=0.045,P<0.05)significantly differed according to sex.The AC and BD measurements before and during surgery were not significantly different according to age,body mass index,hernia side or hernia type(P>0.05).CONCLUSION The application of this technology can aid in determining the most appropriate dissection range and patch size.
文摘BACKGROUND Currently,very few studies have examined the analgesic effectiveness and safety of dexmedetomidine-assisted intravenous-inhalation combined general anesthesia in laparoscopic minimally invasive surgery for inguinal hernia.AIM To investigate the analgesic effect and safety of dexmedetomidine-assisted intravenous-inhalation combined general anesthesia in laparoscopic minimally invasive surgery for inguinal hernia.METHODS In this retrospective study,94 patients scheduled for laparoscopic minimally invasive surgery for inguinal hernia,admitted to Yiwu Central Hospital between May 2022 and May 2023,were divided into a control group(inhalation combined general anesthesia)and a treatment group(dexmedetomidine-assisted intrave-nous-inhalation combined general anesthesia).Perioperative indicators,analgesic effect,preoperative and postoperative 24-hours blood pressure(BP)and heart rate(HR),stress indicators,immune function levels,and adverse reactions were com-pared between the two groups.RESULTS Baseline data,including age,hernia location,place of residence,weight,monthly income,education level,and underlying diseases,were not significantly different between the two groups,indicating comparability(P>0.05).No significant difference was found in operation time and anesthesia time between the two groups(P>0.05).However,the treatment group exhibited a shorter postoperative urinary catheter removal time and hospital stay than the control group(P<0.05).Preoperatively,no significant differences were found in the visual analog scale(VAS)scores between the two groups(P>0.05).However,at 12,18,and 24 hours postoper-atively,the treatment group had significantly lower VAS scores than the control group(P<0.05).Although no significant differences in preoperative hemodynamic indicators were found between the two groups(P>0.05),both groups experienced some extent of changes in postoperative HR,diastolic BP(DBP),and systolic BP(SBP).Nevertheless,the treatment group showed smaller changes in HR,DBP,and SBP than the control group(P<0.05).Preoperative immune function indicators showed no significant differences between the two groups(P>0.05).However,postoperatively,the treatment group demonstrated higher levels of CD3+,CD4+,and CD4+/CD8+and lower levels of CD8+than the control group(P<0.05).The rates of adverse reactions were 6.38%and 23.40%in the treatment and control groups,respectively,revealing a significant difference(χ2=5.371,P=0.020).CONCLUSION Dexmedetomidine-assisted intravenous-inhalation combined general anesthesia can promote early recovery of patients undergoing laparoscopic minimally invasive surgery for inguinal hernia.It ensures stable blood flow,improves postoperative analgesic effects,reduces postoperative pain intensity,alleviates stress response,improves immune function,facilitates anesthesia recovery,and enhances safety.
文摘This study aimed to explore the application effect of the medical and nursing integration working mode in children with inguinal hernia undergoing laparoscopic surgery and to provide a basis for its clinical promotion.A total of 70 children with inguinal hernia admitted to our hospital from July 2023 to June 2024 and treated with laparoscopic surgery were selected as study subjects and randomly divided into an observation group and a control group,with 35 cases in each.Both groups received routine nursing care,while the observation group additionally adopted the integrated medical and nursing working mode,including systematic health education,psychological interventions,and postoperative follow-up from admission to discharge.The anxiety and depression scores of the two groups before and after surgery,medical compliance index,and incidence of complications during hospitalization were compared.Results showed that the preoperative anxiety scores of the observation and control groups were(14.01±1.07)and(14.62±2.31),respectively,with no statistically significant difference(P>0.05);however,postoperative anxiety scores were significantly lower in the observation group(4.01±0.77)compared to the control group(6.62±0.31)(P<0.05).Similarly,preoperative depression scores were(15.11±1.22)in the observation group and(15.41±2.01)in the control group(P>0.05),but postoperative depression scores were significantly reduced in the observation group(4.24±0.61)compared to the control group(7.12±0.54)(P<0.05).After intervention,the medical compliance behavior index in the observation group was(83.31±5.92),significantly higher than(75.34±6.73)in the control group(P<0.05).Regarding postoperative complications,only 1 case(2.86%)occurred in the observation group,while 8 cases(22.86%)were reported in the control group,showing a statistically significant difference(P<0.05).In conclusion,the medical and nursing integration working mode effectively improves the perioperative psychological state of children,enhances medical compliance,reduces postoperative complications,and is worthy of widespread clinical application.
基金Supported by Research Unit of Minimally Invasive Pediatric Surgery on Diagnosis and Treatment,Chinese Academy of Medical Sciences,No.2021RU016.
文摘BACKGROUND Laparoscopic surgery,with the advantage of less trauma,has been predominantly performed to treat pediatric inguinal hernia.However,the traditional three-port laparoscopic surgery remains extremely traumatic for children,whereas singleport laparoscopic surgery causes less damage to children than traditional laparoscopy.However,single-port laparoscopic surgery is more challenging;thus,studies on the effect of its application in pediatric inguinal hernia remain relatively limited.AIM To analyze the association of single-incision laparoscopic herniorrhaphy needle treatment with surgical outcomes,postoperative complications,and serum inflammation in pediatric inguinal hernia.METHODS This retrospective study included 113 pediatric patients with inguinal hernia who underwent surgery at the Children’s Hospital,Capital Institute of Pediatrics,from April 2022 to May 2023.Participants were categorized into the observation group(single-incision laparoscopic herniorrhaphy needle,n=60)and the control group(two-port laparoscopic surgery,n=53).Comparative analyses involved surgical duration,intraoperative blood loss,and length of hospital stay.C-reactive protein(CRP)and white blood cell count(WBC)levels were measured preoperatively and 24 hours postoperatively.Postoperative pain was evaluated with the face,legs,activity,cry,and Consolability scale.Further,the incidence of complications,recurrence,and reoperation rates was assessed.Logistic regression was employed to determine independent risk factors related to poor prognosis.RESULTS The observation group demonstrated significantly reduced intraoperative blood loss and shorter hospitalization compared to the control group(P<0.05).Both groups demonstrated increased CRP and WBC levels postoperatively,but the observation group exhibited significantly lower levels(P<0.05).Further,pain scores at 24 hours postoperatively were significantly lower in the observation group(P<0.05).Additionally,the observation group experienced fewer adverse events,recurrence rates,and reoperations compared to the control group(P<0.05).Logistic regression analysis determined increased postoperative stress markers and surgical technique as independent predictors of recurrence(P<0.05).CONCLUSION Single-incision laparoscopic herniorrhaphy needle treatment for pediatric inguinal hernia exhibits significant efficacy,effectively reduces postoperative complications,ensures a more concealed surgical incision,and promotes faster postoperative recovery than conventional two-port laparoscopy.This approach merits wider application.
文摘Objective:To explore the effect of medical and nursing integration mode on the nursing care of patients with inguinal hernia treated by tension-free repair.Methods:A total of 76 cases of inguinal hernia patients admitted to the hospital from September 2023 to August 2024 were selected as study subjects.They were divided into 38 cases each in the control group and the observation group by using the random number table method.The patients in the control group were cared for by the traditional postoperative care mode and the patients in the observation group were given additional medical and nursing care based on the control group,and were observed and analyzed for pain relief,infection,hospital stay,and hospital costs.Results:The VAS score of patients in the observation group was(7.91±2.21)at 1d postoperation and(11.04±3.24)at 1d postoperation in the control group,which was significantly lower than that of the control group,with a statistically significant difference(P<0.05),and the VAS score of the patients at 6 months postoperation was(4.82±1.81),which was not statistically significant when compared with that of the control patients(4.79±1.45),which was not statistically different from those of the control group(P>0.05);3 cases of infection occurred in the at 3d,accounting for the total number of observation group postoperative patients(7.89%),and compared with control group with postoperative 5 cases of infection occurred in the 3 days,accounting for of the total number of patients(13.16%),the postoperative infection rate of the patients in the observation group was significantly reduced,and the difference was statistically significant(P<0.05).The number of hospitalization days as well as the hospitalization costs of the observation group were significantly lower than those of the control group,and the difference was statistically significant(P<0.05).Conclusion:The integrated model of medical care has significant advantages in the care of patients with inguinal hernia treated with tension-free repair,which can effectively alleviate early postoperative pain,reduce the rate of infection,shorten the length of hospital stay,and reduce the cost of hospitalization.
文摘BACKGROUND The most common causes of scrotal enlargement in patients include primary tumor of the scrotum,inflammation,hydrocele of the tunica vaginalis,and indirect inguinal hernia;scrotal enlargement caused by external tumors of the scrotum is rare.The patient had both a greater omentum tumor and an inguinal hernia,and the tumor protruded into the scrotum through the hernia sac,which is even rarer.Moreover,omental tumors are mostly metastatic,and primary omental fibroma is rare.CASE SUMMARY Here,we report a rare case of a 25-year-old young man with scrotal enlargement and pain for 3 months.Preoperative examination and multidisciplinary discu-ssions considered intra-abdominal tumor displacement and inguinal hernia,and intraoperative exploration confirmed that the greater omentum tumor protruded into the scrotum.Therefore,tumor resection and tension-free inguinal hernia repair were performed.The final diagnosis was benign fibroma of the greater omentum accompanied by an indirect inguinal hernia.CONCLUSION This unusual presentation of a common inguinal hernia disease illustrates the necessity of performing detailed history taking,physical examination,and imaging before surgery.
基金Supported by Wu Jieping Medical Foundation,No.320.6750.18396Nantong“14th Five-Year”Science and Education to Strengthen Health Project,General Surgery Medical Key Discipline,No.42and Nantong Municipal Commission of Health and Family Planning,No.MS2022005.
文摘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.
文摘Inguinal hernia in children is a congenital pathology in children linked to the persistence of the peritoneo-vaginal canal in children and the NüCK canal in girls;persisting into adulthood. This work aimed to study inguinal hernia in children in the general surgery department of the Reference Health Center of Commune I of the Bamako District;to determine the frequency of inguinal hernia;describe the epidemiological, clinical and therapeutic aspects of inguinal hernias and in order to evaluate the cost of treatment. This was a prospective study from April 2017 to March 2018 during which 60 children with an inguinal hernia were collected. Inguinal hernias in children represented 9.23% of patients operated on in the department. The average age was 59.23 months with extremes of one month and 180 months and a standard deviation of 49.23 years. The male sex was dominant with a sex ratio equal to 9:1. The notion of prematurity was found in 11.7% and was associated with a testicle not in place in 1.7% of cases. 41.7% of our patients were referred by a doctor and 66.7% of patients presented with painless, intermittent inguino-scrotal swelling (83.3% of cases). The hernia was discovered before one week of life in 50% of cases. Inguinal swelling was absent in 11.7% but observed intraoperatively. The inguinal hernia was unilateral in 91.7% of cases and 70% of hernias were discovered by the parents during pushing efforts. The inguinal hernia was located on the right in 61.7% of cases. The hernia swelling was soft, painless, impulsive and reducible in 78.3% of cases. The swelling was inguino-scrotal in 58.3% of cases. The hernia was simple in 95% of patients and hernial strangulation was observed in 3 cases or 5% of cases. 98.3% of patients were ASA I. The treatment was carried out openly in all our patients including closure of the vaginal peritoneal canal in 95% of cases under general anesthesia in 98.3% of cases. The morbidity rate was 8.4% (surgical site infection: 6.7% of cases and hematoma: 1.7%). The immediate consequences were simple in 96.6% of cases. No cases of recurrence occurred during the 6 months after the intervention. The average cost of care was estimated at 69,743 FCFA.
文摘Objective:A comprehensive meta-analysis based on the latest randomized controlled trials(RCTs)was conducted to investigate the effects of transcutaneous electrical nerve stimulation(TENS)on patients undergoing treatment after inguinal hernia surgery.Methods:A detailed search of Embase,PubMed,Web of Science,and the Cochrane Library was performed for RCTs investigating the use of TENS during inguinal hernia surgery up to September 28,2021.The Cochrane tool was applied to assess the risk of bias in the included studies.Results:Seven eligible RCTs with a total of 379 cases were included.The meta-analysis showed a mean difference(MD)in VAS of-1.61[95%CI:-2.20-1.02,P<0.00001]at 2 hours post-operation,VAS MD=-1.33 at 4 hours post-operation[95%CI:-2.84-0.18,P=0.09],VAS MD=-2.36 at 8 hours post-operation[95%CI:-4.04-0.69,P=0.006],and VAS MD=-1.75 at 24 hours post-operation[95%CI:-2.64-0.85,P=0.0001].The cortisol level MD at 24 hours post-operation was-52.56[95%CI:-168.8-63.76,P=0.38].Conclusion:TENS significantly reduces postoperative pain following inguinal hernia surgery and promotes patient recovery.TENS is recommended for patients undergoing inguinal hernia surgery.However,further high-quality studies are needed to confirm additional effects.
文摘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.
文摘We present a case report of laparoscopic herniorrhaphy in an infant with ovarian prolapse. Using this case study, we demonstrate the role of the ovarian ligamentous apparatus. A structure appearing like the male gubernaculum was identified. The anatomical and functional role of this “gubernaculum” will be the subject of discussion. Further detailed laparoscopic examinations are indicated to better understand the ligamentous anatomy of ovarian prolapse.
文摘Objective: To study the diagnostic and therapeutic aspects of uncomplicated inguinal hernias in the general surgery unit of CSRéf CII. Method: This was a prospective, descriptive, single-centre study from 1 January 2016 to 31 December 2016 of 84 patients operated on for inguinal hernias in the general surgery unit of CSRéf CII. Results: Inguinal hernia accounted for 8% of surgical consultations and hernia repair accounted for 30.22% of surgical procedures. Hernia repair accounted for 30.22% of surgical procedures. The male sex was the most represented with a ratio of 7.40. The average age of our patients was 43.19 years. Recurrence occurred in 10% of cases. The right side was most affected in 71.43% of cases, 19.05% on the left side in;it was bilateral in 09.52%. Local anaesthesia was used in 67.86% of our patients, general anaesthesia in 13.09% of cases and locoregional anaesthesia in 19.05% of cases. The hernia was external oblique in 75% of cases. Shouldice’s technique was the most used with 88%;Bassini’s technique was used in 7% and Mac Vay’s in 5% of cases. The postoperative course was simple in 96.43% of cases, with an early postoperative morbidity rate of 3.57%, one case of wall abscess and two cases of parietal haematoma. No deaths were observed during our study. Conclusion: The new methods of tension-free cure should be used more and more by our users in our facilities.
文摘Groin hernias include indirect inguinal, direct inguinal, and femoral hernias. Obturator and supravesical hernias appear very close to the groin. High-quality repairs are required for groin hernias. The concept of "tension-free repair" is generally accepted, and surgical repairs with mesh are categorized as "hernioplasties". Surgeons should have good knowledge of the relevant anatomy. Physicians generally focus on the preperitoneal space, myopectineal orifice, topographic nerves, and regional vessels. Currently, laparoscopic surgery has therapeutic potential in the surgical setting for hernioplasty, with laparoscopic transabdominal preperitoneal(TAPP) repair appearing to be a powerful tool for use in adult hernia patients. TAPP offers the advantages of accurate diagnoses, repair of bilateral and recurrent hernias, less postoperative pain, early recovery allowing work and activities, tension-free repair of the preperitoneal(posterior) space, ability to cover obturator hernias, and avoidance of potential injury to the spermatic cord. The disadvantages of TAPP are the need for general anesthesia, adhering to a learning curve, higher cost, unexpected complications related to abdominal organs, adhesion to the mesh, unexpected injuries to vessels, prolonged operative time, and as-yet-unknown long-term outcomes. Both technical skill and anatomical familiarity are important for safe, reliable surgery. With increasing awareness of the importance of anatomy during TAPP repair, we address the skills and pitfalls during laparoscopic TAPP repair in adult patients using illustrations and schemas. We also address debatable points on this subject.
文摘AIM To study the utility of single-incision totally extraperitoneal inguinal hernia repair with intraperitoneal inspection.METHODS A 2 cm transverse skin incision was made in the umbilicus, extending to the intraperitoneal cavity. Carbon dioxide was insufflated followed by insertion of laparoscope to observe the intraperitoneal cavity. The type of hernia was diagnosed and whether there was the presence of intestinal incarceration was confirmed. When an intestinal incarceration in the hernia sac was found, the forceps were inserted through the incision site and the intestine was returned to the intraperitoneal cavity without increasing the number of trocars. Once the peritoneum was closed, totally extraperitoneal inguinal hernia repair was performed, and finally, intraperitoneal observation was performed to reconfirm the repair.RESULTS Of the 75 hernias treated, 58 were on one side, 17 were on both sides, and 10 were recurrences. The respective median operation times for these 3 groups of patients were 100 min(range, 66 to 168), 136 min(range, 114 to 165), and 125 min(range, 108 to 156), with median bleeding amounts of 5 g(range, 1 to 26), 3 g(range, 1 to 52), and 5 g(range, 1 to 26), respectively. Intraperitoneal observation showed hernia on the opposite side in 2 cases, intestinal incarceration in 3 cases, omental adhesion into the hernia sac in 2 cases, severe postoperative intraperitoneal adhesions in 2 cases, and bladder protrusion in 1 case. There was only 1 case of recurrence.CONCLUSION Single-incision totally extraperitoneal inguinal hernia repair with intraperitoneal inspection makes hernia repairs safer and reducing postoperative complications. The technique also has excellent cosmetic outcomes.
文摘BACKGROUND Inguinal hernia is a common clinical manifestation in children with a low selfhealing rate.AIM To determine the effect of laparoscopic surgery on indirect inguinal hernia and the risk factors for postoperative recurrence and to provide a reference for the clinical treatment and prevention of recurrence.METHODS We selected 360 children who underwent laparoscopic high ligation in our hospital as the laparoscopic group and 120 patients treated for inguinal hernia with conventional surgery as the control group.The operation time,blood loss,incision length,hospitalization time,total hospitalization cost and surgical complications were compared between the two groups.According to telephone follow-up or return visits,the children who had recurrence within 2 years after the operation in the laparoscopic group were analyzed,and the laparoscopic high ligation hernia sac level was analyzed by the logistic multifactor method.Ligation was used to treat recurrence in children with inguinal hernia.RESULTS The operation time,blood loss,length of incision,and length of hospital stay in the laparoscopic group were lower than those in the control group(P<0.05).The total hospitalization cost in the laparoscopic group was higher than that in the control group(P<0.05).The operative complication rate was 1.67%lower than that in the control group(12.50%)(P<0.05).In 360 children with laparoscopic high ligation of the hernia sac,14 patients had recurrence within 2 years after surgery.After analysis,14 cases in the recurrence group did not recur.The preoperative incarceration rate,inner ring diameter,ligature use and age difference were statistically significant(P<0.05).According to logistic regression multivariate analysis,an inner ring diameter≥1.0 cm,the use of an absorbable ligature line and age>3 years increased the risk of postoperative recurrence in children with inguinal hernia after laparoscopic high ligation of the hernia sac(P<0.05).CONCLUSION Laparoscopic surgery for indirect inguinal hernia in children has the advantages of low trauma and a rapid postoperative recovery.An inner ring diameter≥1.0 cm,the use of absorbable ligature,and age>3 years may increase the risk of recurrence after laparoscopic high ligation of the hernia sac.
文摘GIANT hydronephrosis is a rare urological entity. It was first defined as the presence of more than 1000 mL of fluid in the collecting sys-tem.1 That disease is seen more often in males
基金Supported by the Medical Science Research Project of Hebei Provincial Health Commission,No. 20211642Key Research and Development Project of Hebei Province,No.21377773D
文摘BACKGROUND Mesh plug(MP)erosion into the intra-abdominal organs is a rare but serious long-term complication after inguinal hernia repair(IHR),and may lead to aggravation of symptoms if not treated promptly.It is difficult to diagnose MP erosion as there are no obvious specific clinical manifestations,and surgery is often needed for confirmation.In recent years,with the increased understanding of postoperative complications,MP eroding into the intra-abdominal organs has been a cause for concern among surgeons.CASE SUMMARY A 50-year-old man was referred to the Department of General Surgery with the complaint of abdominal pain in the right lower quadrant for 2 d.He had a surgical history of right open IHR and partial thyroidectomy performed 20 years and 15 years ago,respectively.Computed tomography revealed a circinate highdensity image with short segmental thickening of the ileum stuck to the abdominal wall,and no evidence of recurrent inguinal hernia.Laparoscopic abdominal exploration confirmed adhesion of the middle segmental portion of the ileal loop to the right inguinal abdominal wall;the rest of the small intestine was normal.Further exploration revealed migration of the polypropylene MP into the intraperitoneal cavity and formation of granulation tissue around the plug,which eroded the ileum.Partial resection of the ileum,including the MP and end-to-side anastomosis with an anastomat,was performed.CONCLUSION Surgeons should aim to improve their ability to predict patients at high risk for MP erosion after IHR.
文摘We report a case of surgically proved left-sided torsion of the greater omentum that caused secondary by untreated inguinal hernia. Case A 36-year-old man presented to our hospital with abdominal pain. He had been diagnosed with a left inguinal hernia, but he had not received any treatments. Contrast-enhanced computed tomography （CT） of the abdomen showed a large fat density mass below the Sigmoid colon and left inguinal hernia with incarcerated fat. Exploratory laparotomy revealed torsion of the greater omentum with small bloody ascites. The greater omentum was twisted into one and a half circles and entered into a left inguinal hernia. An omentectomy with a repair of left inguinal hernia was performed. A resected omentum was submitted for pathological examination, which showed hemorrhagic infarction. Omental torsion is a rare cause of acute abdominal pain but should be included in the differential diagnoses of acute abdomen, especially in patients with untreated inguinal hernia.
基金Supported by Science and Technology Fund of Tianjin Health and Family Planning Commission,No.16KG103Tianjin Health Science and Technology Project,No.ZC20162.
文摘BACKGROUND Primary omental tumors are uncommon,and omental fibromas account for 2%of these tumors.Due to the low incidence of omental fibromas and the limited relevant literature,it is challenging for clinicians to make an accurate diagnosis of this condition,especially before surgery.CASE SUMMARY A 30-year-old man was admitted to the hospital because of a left epididymal mass with vague discomfort for more than 1 mo.A physical examination was performed,and the findings showed that the epididymal mass may have entered the abdominal cavity.Pelvic computed tomography was performed in our hospital and revealed a left inguinal hernia with a mass in the hernial contents,and no masses were found in the left epididymis.A traditional inguinal hernia incision was made.Intraoperative hernia contents were found to be of the greater omentum,and a 2.5 cm-diameter mass was found at the distal end of the greater omentum.The scrotum and epididymis did not exhibit other masses.Then,the mass of the greater omentum was excised.Intraoperative frozen pathological examination suggested a spindle cell tumor.The postoperative pathological examination suggested that the mass was an omental angiofibroma.Postoperatively,the patient recovered well and was discharged.Outpatient re-examinations were performed at 1 mo and half a year after the operation and showed no obvious abnormalities.CONCLUSION Due to the low morbidity rate associated with and latent nature of omental tumors,these tumors are difficult to diagnose preoperatively;thorough medical history taking,detailed physical examinations,and necessary imaging auxiliary examinations can help clinicians diagnose and treat these cases.
