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Application of Transverse Fascia in Inguinal Hernia Repair

Objective To investigate the application of transverse fascia in inguinal hernia repair. Methods In this study, 617 patients underwent inguinal hernia repair between January 1990 and December 2005 in our hospital were included, which were divided into two groups according to different operative ways: transverse fascia method group (n=337) and Bassini method group (n=280). Then intraoperative results, postoperative complications, and rehabilitated results of patients in two groups were compared. Results Compared with Bassini method group, the patients in transverse fascia method group did not show significant difference in operative time and blood loss during operation (Pgt;0.05). The differences of severe postoperative pain, testicular swelling, the time of the body’s restore for normal activities, and recurrence rate of patients between two groups were significant (Plt;0.05), while the difference of hematoma of scrotum and infection of incisional wound (Pgt;0.05). Conclusion The strengthening of posterior wall by transverse fascia and reconstruction of inner ring is a simple and effective method for inguinal hernia repair.

Important Role of Preperitoneal Space in Laparoscopic Transabdominal Preperitoneal and Totally Extraperitoneal Hernia Repair

Objective　To explore the important role of preperitoneal space in laparoscopic transabdominal preperitoneal （TAPP） and totally extraperitoneal （TEP） hernia repair. Methods　The clinical data of 66 patients （78 sides） performed laparoscopic TAPP and TEP hernia repair from January 2008 to April 2011 in this hospital were analyzed retrospectively. Results　TAPP hernia repair were performed in 16 cases （20 sides），TEP hernia repair were performed in 50 cases （58 sides）. Three cases of TEP hernia repair transferred to TAPP hernia repair. The unilateral operation time was （86.92±36.38） min，intraoperative bleeding was （6.08±3.43） ml. Postoperative complication rate was 16.7% （11/66），including 3 cases of postoperative serum swelling，3 cases of temporary paraesthesia of nerve feeling in the repair area，2 cases of scrotum emphysema，2 cases of urinary retention，and 1 case of intestinal obstruction. There were 2 cases of recurrence. The hospital stay was （4.52±0.99） d. The return to activities and working time was （10.32±1.86） d after discharge. Sixty-six cases were followed up for （18.56±1.96） months （range 1-38 months），the patch infection，chronic pain，and testicular atrophy complications were not been observed. Conclusions　Acquainting and mastering laparoscopic preperitoneal space and its important structure are the key to avoid intraoperative and postoperative complications of laparoscopic inguinal hernia repair.

Emphasis on Prevention and Treatment of Postoperative Complication for Hernia Repair

Re-Repair of Recurrent Incisional Hernia Following Repaired with Prosthetic Mesh

老年復發性腹股溝疝的修復

Clinical Analysis of Femoral Hernia in 38 Patients

目的　探討股疝的發病特點、診斷注意事項、誤診分析及治療方法。方法　回顧性分析我院1993年1月至2008年1月期間38例股疝患者的臨床資料。結果　38例患者年齡均在40歲以上，全部行手術治療，1例術后3 d因心肌梗死死亡，1例因腸壞死、多器官功能衰竭死亡，余36例均痊愈出院，術后平均隨訪72個月無復發。結論　股疝容易嵌頓，中老年患者多見,臨床上易被誤診，應盡早確診，及時手術。

Experience of Low Tension Herniorrhaphy for Inguinal Hernia (Analysis of 126 Cases)

目的探討提高腹股溝疝的治療效果。方法回顧性總結我院1990~2001年采用低張力疝修補術治療126例腹股溝疝的經驗。 結果126例患者手術過程順利，手術時間平均45 min, 平均住院8 d，無傷口感染。術后并發尿潴留5例，陰囊積液4例，經對癥治療后痊愈出院。本組病例術后隨訪2年無一復發，87例隨訪2~7年，僅1例復發。結論該術式符合解剖生理特征，掌握其手術適應證，可以避免術后復發。

Value of Tension-Free Inguinal Hernioplasty under Local Anaesthesia in Community Hospitals

目的　探討局部麻醉（以下簡稱局麻）腹股溝疝無張力修補術在基層醫院的應用價值。方法　分析內蒙古醫學院附屬人民醫院2010年10月至2011年12月期間242例行局麻腹股溝疝修補手術患者的臨床資料。結果　除1例因過度緊張而停止手術外，其余手術順利。平均手術時間50min，所有患者術后0.5～4h （平均2h） 均能下床活動，切口疼痛時間0.5～1d。無一例發生尿潴留；12例患者術后陰囊輕-中度水腫，切口感染1例。全部病例術后觀察1～2d出院。門診隨訪2～15個月（平均8個月），復發2例。結論　局麻下腹股溝疝無張力修補術安全、疼痛輕微、禁忌證少、復發率及費用低，值得在基層醫院推廣。

Clinical Value of Laparoscopy Via Veress Needle with Thread in Children with Inguinal Hernia

ObjectiveTo investigate the clinical value of veress needle with thread for laparoscopic high ligation of hernia sac in children. MethodsThe clinical data of 56 cases of pediatric inguinal hernia using laparoscopic high ligation of hernia sac with veress needle from May 2013 to May 2014 were analyzed retrospectively. ResultsAll patients were successfully carried out operation by laparoscopic high ligation of hernia sac.Forty-one cases underwent unilateral surgery, and operative time was 6-18 min (mean 9.6 min); 15 cases underwent bilateral surgery, and operative time was 10-32 min (mean 14.3 min).Nine cases of contralateral recessive hernia were found and ligated during operation.There was no complications, such as scrotal edema, scrotal gas or incision infection after operation, and all patients were discharged in l-2 days after operation.No recurrence or testicular dysplasia was found during 3 to 15 months (mean 10.8 months) follow-up. ConclusionsThere are many advantages in laparoscopic high ligation of hernia sac with veress needle, such as less damage, hidden incision, faster recovery, shorter hospital stay, simple operation, and better efficacy.We can find contralateral recessive hernia during operation and avoid second surgery with high clinical value, therefore it is worthy of clinical application.

Clinical Comparative Study of Tension-Free Herniorrhaphy with Different Suture

目的　觀察運用兩種不同縫線固定修補材料對疝修補術后的復發、切口感染、慢性疼痛等并發癥發生情況。方法　對2008年4月至2010年4月期間筆者所在科室收治的250例腹股溝疝患者行無張力疝修補手術時，采用多股絲線或可吸收合成縫線固定修補材料進行前瞻性對比研究。結果　2組患者術后疝復發、切口感染和切口疼痛（包括慢性疼痛）發生率間的差異均無統計學意義（P＞0.05）。結論　腹股溝疝無張力修補術后的復發、切口感染、慢性疼痛等并發癥的發生與縫線選擇無關。術者的操作技巧、嚴格的無菌操作原則、徹底止血以及組織損傷小才是防止術后感染、慢性疼痛等并發癥發生的重要因素。