Objective To assess the significance of multi-detector row CT in differential diagnosis of the inguinal hernia and femoral hernia. Methods CT images which were reconstructed by multi-planer reconstruction （MPR） of 260 patients with inguinal hernia and femoral hernia who treated in our hospital form Oct. 1， 2012 to Oct. 31， 2013 were analyzed retrospectively， for exploring the relationship between sac and anatomic structure in the groin area. Results There were 146 patients with indirect hernia （75 in right， 60 in left， and 11 in bilateralism）， 82 patients with direct hernia（39 in right， 34 in left， and 9 in bilateralism）， and 32 patients with femoral hernia （17 in right and 15 in left）. The 157sacs of patients with indirect hernia originated lateral to the inferior epigastric artery， entered the inguinal canal and through the deep ring， which mainly located anterior （103/157， 65.6%） or anteromedial （36/157， 22.9%） to the spermatic cord or round ligament. The 91 sacs of patients with direct hernia originated medial to the inferior epigastric artery， and mainly located medial to the spermatic cord （70/91， 76.9%）. Sacs of both indirect hernia and direct hernia located anterosuperior to the inguinal ligament. The 32 sacs of patients with femoral hernia located posterior to the inguinal ligament and inside the “radiological femoral triangle” of coronal views. Conclusions The MPR images available from multi-detector row CT permit the accurate diagnosis of groin hernias. By using simple anatomical criteria， direct hernia， indirect hernia， and femoral hernia can be reliably distinguished．
ObjectiveTo evaluate the value of high-frequency color Doppler ultrasonography in the diagnosis of femoral hernia.
MethodsThe ultrasonographic features of 39 femoral hernias in 37 patients treated between March 2008 and October 2013 were retrospectively analyzed, and the results were confirmed by surgery.
ResultsThirty-nine femoral hernias were diagnosed by surgery, including 19 in the right side, 16 in the left side, and 2 with double-side hernias. Thirty-seven femoral hernias were diagnosed with ultrasonography. Two femoral hernias were misdiagnosed as lipoma in one, and as enlarged lymph nodes in one, respectively. Ultrasound diagnosis accurate rate was 94.9% (37/39). Hernia content could be seen through surgery in 28 cases, and the ultrasound accurate rate in assessing the hernia content was 85.7% (24/28).
ConclusionUltrasonography is the first choice for improving the diagnosis efficacy of femoral hernia.
ObjectiveTo compare the outcomes after mini-mesh approach to modified Kugel technique in femoral hernia repair.MethodsThe clinical data of 99 patients with primary unilateral femoral hernia who were admitted to The First Affiliated Hospital of Zhengzhou University from July 2012 to December 2016 were prospectively analyzed. A randomized controlled study was performed based on a random number table. All patients were allocated into mini-mesh group and Kugel group. The outcomes including operative time, wound pain scores (1 week after operation), analgesic used, hospital stay after operation, urinary retention, wound infection, seroma, and femoral vein thrombosis were recorded. Patients were followed-up at 3 months, 1 year, and 2 years after operation. Follow-up data included chronic pain, foreign body feeling, quality of life, and recurrence.ResultsNinety-seven patients completed follow-up. There were 48 patients in the Kugel group and 49 patients in the mini-mesh group. The operation time of the mini-mesh group was significantly shorter than that of the Kugel group (P=0.030). There was no significant difference in analgesic used, hospital stay after operation, urinary retention, visual analog scale of wound pain at rest (VAS) 1 week postoperatively, and VAS of wound pain on coughing 1 week postoperatively between the two groups (P>0.05). No patient had wound infection, seroma or femoral vein thrombosis in the two groups. At 3 months, 1 year, and 2 years follow-up, there was no significant difference in chronic pain, foreign body feeling, and SF-36 score between the two groups (P>0.05). Ninety-seven patients completed 2 years follow-up, with no recurrence occurred during follow-up period.ConclusionsThe operative outcomes of mini-mesh repair are comparable to modified Kugel repair with a reduced operation time in femoral hernia patients. It is a safe and promising technique.
Objective
To explore the effectiveness of tension-free herniorrhaphy with Ultrapro Plug (UPP) mesh through a femoris approach for femoral hernia repair.
Methods
Between March 2009 and January 2013, 123 patients (126 sides) underwent tension-free herniorrhaphy with UPP mesh through a femoris approach. There were 17 males and 106 females, aged 32-95 years (mean, 63.3 years). The locations were the left side in 48 cases, the right side in 72 cases, and both sides in 3 cases. The disease duration was 1 month to 26 years (median, 25 months). Of 123 cases, 35 cases (36 sides) were reducible and 88 cases (90 sides) were irreducible. According to American Society of Anesthesiologists (ASA) classification, 20 cases were rated as grade I, 42 cases as grade II, 56 cases as grade III, and 5 cases as grade IV. The operation time, postoperative hospitalization time, complication, recurrence, and chronic pain were recorded.
Results
The operation time was 7-28 minutes (mean, 14.5 minutes); postoperative hospitalization time was 2-96 hours (mean, 19.4 hours) (112 patients discharged from hospital within 24 hours). Wound dehiscence occurred in 1 case and fat liquefaction in 2 cases. A total of 119 patients (122 sides) were followed up 4-50 months (median, 18 months); no recurrence was noted. Two cases (2 sides) suffered from chronic pain after operation, whose visual analogue scale (VAS) was 20 mm and 30 mm, respectively.
Conclusion
Tension-free herniorrhaphy with UPP mesh through a femoris approach should be recommended because it has the advantages of simple operation, short operation time, less complication, and lower incidence of chronic pain.
