The soft-tissue-cutaneous flap adjacent to the abdominal incisional hernia was ultilized to repair huge hernia in 6 cases with success. Patients were followed up for 2y7 years without recurrence. The operative planning, the technique and the matters needing attention were introduced in details. The soft tissues and skin adjacent to hernia used for repair was easy to obtain and a simple technique. The adoption of this operation in hospitals at the grassroots level was feasible.
Objective To investigate the prevention of gangrene of exteriorized colon following transabdomino-perineal saving sphincter resection of rectal cancer. Methods From Aug. 1988 to Feb. 2000, 46 cases of cancer of the rectum were treated by transabdominoperineal saving sphincter with severing the anal sphincters and anorectal ring. During this procedure the anal sphincters and anorectal ring were severed to prevent gangrene of the exteriorized colon. Results In these cases, the exteriorized sigmoid colon had good blood supply and no gangrene was found. Conclusion This method can effectively prevent the gangrene of exteriorized sigmoid colon stump and gives no permanent fecal incontinence.
ObjectiveTo explore the risk factors of recurrence of incisional hernia following incisional hernia tension-free repair.
MethodsThe clinical data of 162 patients with incisional hernia underwent tension-free repair were retrospectively analyzed in this hospital from January 2005 to January 2011. The relationships of incisional hernia recur-rence to gender, age, body mass index, hernia size, abdominal wall defect site, preoperative chronic comorbidities, type of tension-free repair, operation time, and wound healing disorders were analyzed by univariate and multivariate analysis.
ResultsOne hundred and sixty-two patients were followed up 7-70 months with mean 34.5 months. The rate of recur-rence following incisional hernia tension-free repair was 9.26% (15/162). The results of univariate analysis showed that recurrence following incisional hernia tension-free repair was associated with the age (P < 0.05), body mass index (P < 0.05), type of tension-free repair (P < 0.05), hernia size (P < 0.05), and wound healing disorders (P < 0.05). The results of multivariate logistic regression revealed that the body mass index, type of tension-free repair, hernia size, and wound healing disorders were the independent risk factors associated with recurrence following incisional hernia tension-free repair. Fifteen recurrent patients were reperformed successfully. There was no recurrence following up with an average 23 months.
ConclusionsIt is necessary to become familiar with the risk factors for recurrence of incisional hernia in order to eliminate or decrease their effects on the positive outcome of incisional herniorrhaphy. The patients with fat, hernia ring bigger, incorrect opera-tion or wound healing disorders might be easy to relapse. Surgical approach should be individualized for recurrence.
ObjectiveTo evaluate the value of incision closure device in laparoscopic cholecystolithotomy.
MethodsThe clinical data of 130 patients underwent laparoscopic cholecystectomy from Oct. 2014 to Feb. 2015 were retrospectively analyzed. According to the methods of gallbladder suture, 130 cases were divided into two groups, 72 cases underwent traditional manual suture (MS group), and 58 cases underwent incision closure device (ICD group). The operative time, postoperative gastrointestinal function recovery time, bleeding volume, postoperative hospitalization time, hospitalization expenses, complications, and postoperative 6-12 months follow-up of patients in 2 groups were observed.Results One hundred and thirty cases were performed laparoscopic cholecystolithotomy successfully. The operative time and postoperative gastrointestinal function recovery time of ICD group were significantly shorter than those of MS group, the difference was statistically significant (P < 0.05). The hospitalization expenses of the patients in ICD group were significantly higher than those in the MD group (P < 0.05). There were no significant difference between the two groups in the bleeding volume and postoperative hospital stay (P > 0.05). The patients were followed up for 6-12 months, with an average of 8 months, and no complications occurred and stone recurrence.
ConclusionIncision closure device can shorten the time of laparoscopic cholecystolithotomy and postoperative recovery of gastrointestinal function, but the cost is higher. Next development, still need decrease the expend and strengthen clinical promotion.
Objective To evaluate the usefulness of minimal incision technique in total knee arthroplasty (TKA) by comparing the early compl ications after minimal incision TKA and those after traditional incision. Methods From May 2004 to July 2005, 38 patients (46 knees) underwent TKA using the minimal incision technique (minimal incision group), and 43 patients (54 knees) underwent TKA using the traditional incision technique at the same period (traditional incision group). The inimal incision group included 12 male patients (12 knees) and 26 female patients (34 knees), and their ages ranged from 52 to 76 years. Twenty-four patients (28 knees) had osteoarthritis and 14 patients (18 knees) had rheumatic arthritis. The varus deformity of the knee was found in 30 patients (34 knees) and valgus deformity was found in 8 patients (12 knees). TheAmerican Knee Society Score (AKSS) score was 37.5 ± 12.6, and the disease course was (7.5 ± 2.3) years. The raditional incision group included 15 male patients (19 knees) and 28 female patients (35 knees), and their ages ranged from 55 to 82 years. Thirtytwo patients (37 knees) had osteoarthritis and 11 patients (17 knees) had rheumatic arthritis. Varus deformity of the knee was found in 34 patients (41 knees) and valgus deformity was found in 9 patients (13 knees). The AKSS score was 31.1 ± 10.2, and the disease course was (10.1 ± 4.2) years. There were no statistically significant differences in the general data between two groups (P gt; 0.05). Results The incision length, the operation time and the drainage flow were (12.6 ± 1.2) cm, (95 ± 15) minutes and (650.1 ± 10.0) mL in the minimal incision group and (18.7 ± 2.3) cm, (63 ± 11) minutes and (300.0 ± 20.0) mL in the traditional incision group; showing statistically significant differences between two groups (P lt; 0.05). In the minimal incision group, 4 patients (4 knees) developed infections at the operated knees, including 2 early infection and 2 late infection, which were all cured by corresponding treatment. Deep vein thrombosis occurred in 1 patient on the third day after operation and was managed successfully by thrombolytic therapy. Cutaneous necrosis was found in 2 patients on the seventh and ninth postoperative day separately, which healed uneventfully after intensive local treatment. On the twelfth postoperative month, 1 patient had femoral fractured at the site of supracondylar region after a careless fall, but the prosthesis was stable. The fracture was fixed by a plate and healed uneventfully. In the traditional incision group, only 1 patient (1 knee) developed early infection at the operated knee on the tenth postoperative day, which was managed by corresponding treatment. And there were no periprosthetic fracture, cutaneous necrosis or deep vein thrombosis. The patients were followed up for (3.7 ± 0.4) years in the minimalincision group and (3.9 ± 0.6) years in the traditional incision group. At the latest follow-up, the AKSS scores were 78.2 ± 6.7 in the minimal incision group and 81.2 ± 7.3 in the traditional incision group, showing statistically significant ifferences (P lt; 0.05) when compared with those before operation and no statistically significant difference between two groups (P gt; 0.05). Conclusion Minimally invasive TKA has relatively higher compl ication rate than traditional incision. Strict patient inclusion criteria, competent surgery skill, proper instrument and intensive perioperative management are essential to success.
Objective To summarize the surgical technique and curative effect of laparoscopic repair for suprapubic incisional hernia using composite patch. Methods The clinical data of 25 cases performed laparoscopic repair of suprapubic incisional hernia using composite patch from March 2007 to October 2010 were reviewed retrospectively. There were 13 males and 12 females， and aged 35-83 years （median age was 52 years）. Among them 2 patients were recurrences. The distance between the lower margin of hernia defect and pubic arc was less than 5 cm. The composite patch was fixed to the abdominal wall using spiral tacks （Protack） in direct vision. The lower margin of the patch was lower to the pubic arc in 2 cm， and to be fixed to the pubic arc and bilateral pectineal ligament， and it should be extended. Results Laparoscopic repair were successfully performed in all patients without convert to open repair. The max diameter of the hernia ring was 6.1-12.5cm and the average was 9.5 cm. The average operating time was 128 min （ranging from 90 to 180 min）. And the total complication rate was 28% （7/25）， including bladder damage during operation in 1 case， wound seroma upon the patch in 4 cases and cured by aspiration， pain in the operative area and disappeared within one month without intervention in 1 case. Twenty-two patients were followed-up with a follow-up rate of 88%. During a follow-up range of 6-48 months（average 30 months）， one case recurrence occurred in 2 months after the repair with the recurrent rate of 4%. Conclusions Laparoscopic repair of suprapubic incisional hernia is a safe and feasible technique， and the patch should cover and exceed the margin of the defect for 5 cm in all direction. The lower margin of the patch should be fixed to the bilateral pectineal ligament so as to strengthen the fix， and lower the recurrence rate.
ObjectiveTo discuss the effect of three different ways of annulus fibrosus incision on the biomechanical strength of intervertebral disc.
MethodsA total of 30 goats underwent intervertebral disc nucleus pulposus extraction at L3, 4 and L4, 5 by the working channel in group A (n=10), by circular incision in group B (n=10), and by square incision in group C (n=10). The body weight, male and female ratio, age, intraoperative blood loss, and wound healing time were recorded and compared among 3 groups. The survival rate and wound healing situation were observed after operation. At 24 weeks after operation, the goats were sacrificed, MRI images were taken to observe the signal intensity of nucleus pulposus. The disc height of L3, 4 and L4, 5 was measured to calculate the loss of disc height; biomechanical test was used to assess the strength of the disc and anulus. Histological staining was also conducted to observe the repair effect at L4, 5.
ResultsThere was no significant difference in body weight, male to female ratio, age, intraoperative blood loss, and wound healing time among groups (P>0.05). All goats survived to the end of the experiment. MRI examination showed decreased signal intensity in 3 groups, indicating intervertebral disc degeneration. According to modified Thompson classification method, the degree of intervertebral disc degeneration of group A was significantly higher than that of groups B and C (P<0.05), but no significant difference was found between groups B and C (P>0.05). Difference was not significant in intervertebral space height before operation among 3 groups (P>0.05). But after 24 weeks, the intervertebral space height in group A was significantly higher than that in groups B and C (P<0.05), and the intervertebral space height loss in group A was significantly lower than that in groups B and C (P<0.05). The biomechanical strength in group A was also significantly higher than that in groups B and C (P<0.05), but no significant difference was found between group B and group C (P>0.05). HE and Masson staining showed good continuity of annulus fibrosus and clear layers in group A; poor continuity of annulus fibrosus and obvious scar tissues were observed in groups B and C.
ConclusionApplication of working channel may have less destruction of annulus fibrosus, it plays a positive role in the maintenance of biomechanical strength and repair of annulus fibrosus.
Objective To investigate the effect of different degrees of wound eversion on scar formation at the donor site of anterolateral thigh flaps by a prospective clinical randomized controlled study. MethodsAccording to the degree of wound eversion, the clinical trial was designed with groups of non-eversion (group A), eversion of 0.5 cm (group B), and eversion of 1.0 cm (group C). Patients who underwent anterolateral femoral flap transplantation between September 2021 and March 2023 were collected as study subjects, and a total of 36 patients were included according to the selection criteria. After resected the anterolateral thigh flaps during operation, the wound at donor site of each patient was divided into two equal incisions, and the random number table method was used to group them (n=24) and perform corresponding treatments. Thirty of these patients completed follow-up and were included in the final study (group A n=18, group B n=23, and group C n=29). There were 26 males and 4 females with a median age of 53 years (range, 35-62 years). The body mass index was 17.88-29.18 kg/m2 (mean, 23.09 kg/m2). There was no significant difference in the age and body mass index between groups (P>0.05). The incision healing and scar quality of three groups were compared, as well as the Patient and Observer Scar Assessment Scale (POSAS) score [including the observer component of the POSAS (OSAS) and the patient component of the POSAS (PSAS)], Vancouver Scar Scale (VSS) score, scar width, and patient satisfaction score [visual analogue scale (VAS) score]. Results In group C, 1 case had poor healing of the incision after operation, which healed after debridement and dressing change; 1 case had incision necrosis at 3 months after operation, which healed by second intention after active dressing change and suturing again. The other incisions in all groups healed by first intention. At 6 months after operation, the PSAS, OSAS, and patient satisfaction scores were the lowest in group B, followed by group A, and the highest in group C. The differences between the groups were significant (P<0.05). There was no significant difference between the groups in the VSS scores and scar widths (P>0.05). ConclusionModerate everted closure may reduce the formation of hypertrophic scars at the incision site of the anterior lateral thigh flap to a certain extent.
OBJECTIVE To repair the huge incisional hernia of abdominal wall, a new surgical method was introduced. METHODS Eight cases of huge ventral incisional hernia, developed in 3 months to 12 months after operation, were treated in this new method with the defects ranged from 8 cm x 4 cm to 12 cm x 6 cm. RESULTS They were followed up for 6 months to 18 months after operation. The clinical results showed that all of the 8 cases recovered satisfactorily without recurrence. CONCLUSION The new method was recommendable for its advantages of easier manipulation, shortened time, no tissue reaction and less tissue trauma from operation.
Objective To review the clinical operation methods of abdominal incisional hernia. Methods Classification, operation method and fellow-up of 78 patients with abdominal incisional hernia were retrospectively analyzed. Results The average time of fellow-up was 26 months. Nineteen cases were repaired with simple suture with 3 cases (15.8%) recurrence, 57 cases were repaired with man-made material with 2 case （3.4%） recurrence. Conclusions Individual operation method should be chosen according to body condition, classification of the size of abdominal loss and abdominal hypertension. It is an effective method to repair the hernia of abdominal incision with man-made material.
