BACKGROUND The totally preperitoneal(TPP)approach is a new concept that was recently introduced.Although the TPP approach combined with single-incision laparoscopic hernia repair has its own advantages,there is little...BACKGROUND The totally preperitoneal(TPP)approach is a new concept that was recently introduced.Although the TPP approach combined with single-incision laparoscopic hernia repair has its own advantages,there is little evidence reflecting the characteristics and feasibility of either approach.AIM To analyze the potential applications of single-incision laparoscopic TPP(SILTPP)inguinal hernia hernioplasty for the treatment of inguinal hernias.METHODS A total of 152 SIL-TPP surgeries were performed at the First Affiliated Hospital of Ningbo University from February 2019 to November 2022.A single-port,named Iconport,and standard laparoscopic instruments were used during the operation.Demographic data,intraoperative parameters and short-term postoperative outcomes were collected and retrospectively analyzed.RESULTS The demographic data of 152 patients underwent SIL-TPP were shown in Table 1.The average age was 49.5 years(range from 21 to 81 years).The average body mass index was 27.7 kg/m^(2)(range from 17.7 kg/m^(2) to 35.6 kg/m^(2)).SIL-TPP were conducted successfully in 147 patients.Three patients were converted to the SILtransabdominal preperitoneal laparoscopic herniorrhaphy at the initial stage of the study due to a lack of experience.In 2 patients with incisional hernias,an auxiliary operation hole was added during the SIL-TPP procedure,as required for surgery.The mean operative time was 64.5 minutes(range:36.0-110.0 minutes)for unilateral direct and femoral hernias and 81.6 minutes for indirect hernias(range:40.0-150.0 minutes).The mean postoperative hospital stay was 3.4 days.CONCLUSION SIL-TPP is feasible and has advantages for inguinal hernia repair.SIL-TPP has potential benefits for patients with various abdominal wall hernias.Consequently,doctors should be encouraged to actively apply the TPP approach combined with a single incision in their daily work.展开更多
BACKGROUND Compared with open mesh repair,transabdominal preperitoneal(TAPP)hernioplasty results in less chronic postoperative inguinal pain and faster postoperative recovery.However,it may still lead to rare but seri...BACKGROUND Compared with open mesh repair,transabdominal preperitoneal(TAPP)hernioplasty results in less chronic postoperative inguinal pain and faster postoperative recovery.However,it may still lead to rare but serious complications.Here we report a case of intestinal volvulus with recurrent abdominal pain as the only clinical symptom,which occurred 3 mo after TAPP repair for bilateral inguinal hernia.CASE SUMMARY A 50-year-old male patient underwent laparoscopic TAPP for bilateral inguinal hernias.After the operation,he experienced recurring pain in his lower right abdomen around the surgical area,which was relieved after symptomatic treatment.Three months after the surgery,the abdominal pain became severe and was aggravated over time.The whirlpool sign of the mesentery was seen on contrast-enhanced computed tomography(CT).Laparoscopic exploration confirmed that a barb of the V-Loc™suture penetrated the peritoneum,which caused the adhesion of the small intestinal wall to the site of peritoneal injury,forming intestinal volvulus.Since there was no closed-loop obstruction or intestinal ischemia,recurrent abdominal pain became the only clinical manifestation in this case.After laparoscopic lysis of adhesions and reduction of intestinal volvulus,the patient recovered and was discharged.CONCLUSION The possibility of intestinal volvulus should be considered in patients who experience recurrent abdominal pain following TAPP surgery during which barbed V-Loc sutures are used for closing the peritoneum.Contrast-enhanced CT and active laparoscopic exploration can confirm the diagnosis and prevent serious complications.展开更多
Objective： To evaluate the clinical value of laparoscopic inguinal hernia repair in hernioplasty and simultaneous cholecystectomy. Methods： Twenty-eight patients with symptomatic chronic calculous cholecystitis and ...Objective： To evaluate the clinical value of laparoscopic inguinal hernia repair in hernioplasty and simultaneous cholecystectomy. Methods： Twenty-eight patients with symptomatic chronic calculous cholecystitis and synchronous unilateral primary inguinal hernia were performed combined surgery between October 2001 and March 2005. Of them, 10 cases underwent laparoscopic totally extraperitoneal mesh hernia repair （TEP） and laparoscopic cholecystectomy （LC）, 3 cases underwent laparoscopic transabdominal preperitoneal mesh hernia repair （TAPP） and LC, and 15 cases underwent LC and open tension-free hernia repair. Results： All the procedures were performed successfully, 2 patients occurred urinary retention in LC＋open group and 1 patient occurred scrotum seroma in LC＋TEP procedures. During the 6 to 24 months＇ follow-up, no hernia recurrences occurred in all patients. There were 6 patients （40%） in LC ＋open group had discomfort pain in the inguinal region and lasted 1 to 3 months. The operating time was longer in the totally laparoscopic group （TEP＋LC and TAPP＋LC） （104±31 min） than in the LC＋open group （80±28 min） （P〈0. 05）. The intensity of postoperative pain at rest was greater in the LC＋open group at 24 h （P〈0.05） and 48 h （P〈0.05）. No differences between the 2 groups were found in the mean operating costs and oral intake of the postoperative period. But the time resume to walking （2.9 vs 1. 8 d） （P〈0.01） and the mean hospital stay （8.2 vs 4.6 d） （P〈0.001） was longer in the LC＋open group than in the totally laparoscopic group. Conclusion： In the same operating costs, the totally laparoscopic precedure has more advantages of low postoperative pain, quicker resume to walking and less hospital stay than open tension-free hernia repair in hernioplasty and simultaneous LC. Thus, the totally laparoscopic approach is considered to be advantage of the hernioplasty and simultaneous LC.展开更多
Groin hernias include indirect inguinal,direct inguinal,femoral,obturator,and supravesical hernias.Here,we summarize historical turning points,anatomical recognition and surgical repairs.Groin hernias have a fascinati...Groin hernias include indirect inguinal,direct inguinal,femoral,obturator,and supravesical hernias.Here,we summarize historical turning points,anatomical recognition and surgical repairs.Groin hernias have a fascinating history in the fields of anatomy and surgery.The concept of tension-free repair is generally accepted among clinicians.Surgical repair with mesh is categorized as hernioplasty,while classic repair without mesh is considered herniorrhaphy.Although various surgical approaches have been developed,the surgical technique should be carefully chosen for each patient.Regarding as interesting history,crucial anatomy and important surgeries in the field of groin hernia,we here summarized them in detail,respectively.Points of debate are also reviewed;important points are shown using illustrations and schemas.We hope this systematic review is surgical guide for general surgeons including residents.Both a skillful technique and anatomical knowledge are indispensable for successful hernia surgery in the groin.展开更多
Background: Laparoscopic hernioplasty has gained popularity with significant advances in prostheses. Omega-3 coating mesh (C-Qur) is a prosthesis that can be used in the abdominal cavity, and the coating prevents adhe...Background: Laparoscopic hernioplasty has gained popularity with significant advances in prostheses. Omega-3 coating mesh (C-Qur) is a prosthesis that can be used in the abdominal cavity, and the coating prevents adhesion of the mesh to the viscera. We planned a prospective observational study of laparoscopic hernioplasty using C-Qur. Methods: C-Qur was used in laparoscopic hernioplasty over the course of 1 year. We considered laparoscopic approaches as our primary treatment method for abdominal wall hernias. Although only a single incision was made for the majority of the laparoscopic hernioplasties, additional incisions were made when severe adhesions were encountered. For incisional or ventral hernias, a lateral lower incision was made. For inguinal hernias, an umbilical incision was made. Sex, age, diagnosis, number of incisions, additional incisions, morbidity, and follow-up period were evaluated. Results: Twenty-four patients who underwent surgery between May 2010 and April 2011 were included in this study. The median follow-up period was 14 months. The most common early complications included wound pain and edema;however, there were no persistent complications.展开更多
In order to compare the effects of Bassini and tension-free mesh hernioplasty,a total of 552 patients with inguinal hernia who were subjected to surgical treatment in our hospital were randomly divided into the follow...In order to compare the effects of Bassini and tension-free mesh hernioplasty,a total of 552 patients with inguinal hernia who were subjected to surgical treatment in our hospital were randomly divided into the following two groups:the Bassini group(n=269)and the tension-free mesh group(n=283).The recurrence rates,pain,dis-comfort,and other complications were recorded,and the causes of the complications were explored.The recurrence rate in the Bassini group was 8.9%(24/269),significantly higher than that in the tension-free repair group(2.8%,8/283).In addition,the recurrence rates in the Bassini and tension-free groups before 2004 were 12.6%and 5.6%,respectively,which were markedly higher than the rates after 2004(5.3%and 0.7%,respectively).The rate of post-operative discomfort and pain within thefirst three months was higher in the Bassini group compared to the tension-free group(25.7%vs 18.5%,respectively).However,there was no difference after three months in the rate of post-operative discomfort and pain,incidence of infection,or scrotal edema between the two groups.The average hospital stay in the Bassini group was longer than that in the tension-free repair group(7.6�1.2 vs 4.5�2.2 days,respectively),but the cost was lower(4518.0�510 vs 6221.3�578 yuan,respectively).Thus,tension-free mesh hernioplasty is indicated for most inguinal hernia patients due to the low recurrence rate,rapid recovery time,and treatment success,but the traditional Bassini procedure has lower cost and other beneficial effects and is still suitable for some patients.展开更多
BACKGROUND A pelvic floor hernia is defined as a pelvic floor defect through which the intraabdominal viscera may protrude.It is an infrequent complication following abdominoperineal surgeries.This type of hernia requ...BACKGROUND A pelvic floor hernia is defined as a pelvic floor defect through which the intraabdominal viscera may protrude.It is an infrequent complication following abdominoperineal surgeries.This type of hernia requires surgical repair by conventional or reconstructive techniques.The main treatments could be transabdominal,transperineal or a combination.CASE SUMMARY In this article,we present the case of a recurrent perineal incisional hernia,postresection of the left side of the pelvis,testis and lower limbs resulting from a mine disaster 18 years ago.Combined laparoscopic surgery with a perineal approach was performed.The pelvic floor defect was repaired by a biological mesh and one pedicle skin flap.No signs of recurrence were indicated during the 2 years of follow-up.CONCLUSION The combination of laparoscopic surgery with a perineal approach was effective.The use of the biological mesh and pedicle skin flap to restructure the pelvic floor was effective.展开更多
Background: The mechanism of the development of acquired inguinal hernia, especially indirect inguinal hernia, is not well known. Although anatomical studies have been performed to explain development of inguinal hern...Background: The mechanism of the development of acquired inguinal hernia, especially indirect inguinal hernia, is not well known. Although anatomical studies have been performed to explain development of inguinal hernia, they have mainly involved autopsy or temporal findings at the time of hernioplasty. To elucidate the pattern of development of acquired inguinal hernia, we studied the occurrence of inguinal hernia after robotic-assisted laparoscopic prostatectomy (RALP). Methods: From March 2009 to November 2011, RALP for prostatic cancer was performed on 60 patients in our institute. The RALP was performed by one urologist using the da Vinci Surgical System. The postsurgical development of inguinal hernia was diagnosed based on patients’ symptoms. Seven patients were treated with laparoscopic hernioplasty, and one underwent mesh-plug repair. Using video recordings, the laparoscopic findings during RALP and laparoscopic hernioplasty were compared among all patients. Results: Seven of 59 patients (11.9%) developed an inguinal hernia. One patient had a pre-existing pantaloon inguinal hernia at the time of RALP. Eleven inguinal lesions in the seven patients who underwent laparoscopic hernioplasty were reviewed, and all were indirect inguinal hernias. Conclusion: A main factor in the development of inguinal hernia after RALP could be a combination of outer-side intact layers and inner-side hard scar of the inguinal ring, which seems like “out swing door”.展开更多
文摘BACKGROUND The totally preperitoneal(TPP)approach is a new concept that was recently introduced.Although the TPP approach combined with single-incision laparoscopic hernia repair has its own advantages,there is little evidence reflecting the characteristics and feasibility of either approach.AIM To analyze the potential applications of single-incision laparoscopic TPP(SILTPP)inguinal hernia hernioplasty for the treatment of inguinal hernias.METHODS A total of 152 SIL-TPP surgeries were performed at the First Affiliated Hospital of Ningbo University from February 2019 to November 2022.A single-port,named Iconport,and standard laparoscopic instruments were used during the operation.Demographic data,intraoperative parameters and short-term postoperative outcomes were collected and retrospectively analyzed.RESULTS The demographic data of 152 patients underwent SIL-TPP were shown in Table 1.The average age was 49.5 years(range from 21 to 81 years).The average body mass index was 27.7 kg/m^(2)(range from 17.7 kg/m^(2) to 35.6 kg/m^(2)).SIL-TPP were conducted successfully in 147 patients.Three patients were converted to the SILtransabdominal preperitoneal laparoscopic herniorrhaphy at the initial stage of the study due to a lack of experience.In 2 patients with incisional hernias,an auxiliary operation hole was added during the SIL-TPP procedure,as required for surgery.The mean operative time was 64.5 minutes(range:36.0-110.0 minutes)for unilateral direct and femoral hernias and 81.6 minutes for indirect hernias(range:40.0-150.0 minutes).The mean postoperative hospital stay was 3.4 days.CONCLUSION SIL-TPP is feasible and has advantages for inguinal hernia repair.SIL-TPP has potential benefits for patients with various abdominal wall hernias.Consequently,doctors should be encouraged to actively apply the TPP approach combined with a single incision in their daily work.
文摘BACKGROUND Compared with open mesh repair,transabdominal preperitoneal(TAPP)hernioplasty results in less chronic postoperative inguinal pain and faster postoperative recovery.However,it may still lead to rare but serious complications.Here we report a case of intestinal volvulus with recurrent abdominal pain as the only clinical symptom,which occurred 3 mo after TAPP repair for bilateral inguinal hernia.CASE SUMMARY A 50-year-old male patient underwent laparoscopic TAPP for bilateral inguinal hernias.After the operation,he experienced recurring pain in his lower right abdomen around the surgical area,which was relieved after symptomatic treatment.Three months after the surgery,the abdominal pain became severe and was aggravated over time.The whirlpool sign of the mesentery was seen on contrast-enhanced computed tomography(CT).Laparoscopic exploration confirmed that a barb of the V-Loc™suture penetrated the peritoneum,which caused the adhesion of the small intestinal wall to the site of peritoneal injury,forming intestinal volvulus.Since there was no closed-loop obstruction or intestinal ischemia,recurrent abdominal pain became the only clinical manifestation in this case.After laparoscopic lysis of adhesions and reduction of intestinal volvulus,the patient recovered and was discharged.CONCLUSION The possibility of intestinal volvulus should be considered in patients who experience recurrent abdominal pain following TAPP surgery during which barbed V-Loc sutures are used for closing the peritoneum.Contrast-enhanced CT and active laparoscopic exploration can confirm the diagnosis and prevent serious complications.
文摘Objective： To evaluate the clinical value of laparoscopic inguinal hernia repair in hernioplasty and simultaneous cholecystectomy. Methods： Twenty-eight patients with symptomatic chronic calculous cholecystitis and synchronous unilateral primary inguinal hernia were performed combined surgery between October 2001 and March 2005. Of them, 10 cases underwent laparoscopic totally extraperitoneal mesh hernia repair （TEP） and laparoscopic cholecystectomy （LC）, 3 cases underwent laparoscopic transabdominal preperitoneal mesh hernia repair （TAPP） and LC, and 15 cases underwent LC and open tension-free hernia repair. Results： All the procedures were performed successfully, 2 patients occurred urinary retention in LC＋open group and 1 patient occurred scrotum seroma in LC＋TEP procedures. During the 6 to 24 months＇ follow-up, no hernia recurrences occurred in all patients. There were 6 patients （40%） in LC ＋open group had discomfort pain in the inguinal region and lasted 1 to 3 months. The operating time was longer in the totally laparoscopic group （TEP＋LC and TAPP＋LC） （104±31 min） than in the LC＋open group （80±28 min） （P〈0. 05）. The intensity of postoperative pain at rest was greater in the LC＋open group at 24 h （P〈0.05） and 48 h （P〈0.05）. No differences between the 2 groups were found in the mean operating costs and oral intake of the postoperative period. But the time resume to walking （2.9 vs 1. 8 d） （P〈0.01） and the mean hospital stay （8.2 vs 4.6 d） （P〈0.001） was longer in the LC＋open group than in the totally laparoscopic group. Conclusion： In the same operating costs, the totally laparoscopic precedure has more advantages of low postoperative pain, quicker resume to walking and less hospital stay than open tension-free hernia repair in hernioplasty and simultaneous LC. Thus, the totally laparoscopic approach is considered to be advantage of the hernioplasty and simultaneous LC.
文摘Groin hernias include indirect inguinal,direct inguinal,femoral,obturator,and supravesical hernias.Here,we summarize historical turning points,anatomical recognition and surgical repairs.Groin hernias have a fascinating history in the fields of anatomy and surgery.The concept of tension-free repair is generally accepted among clinicians.Surgical repair with mesh is categorized as hernioplasty,while classic repair without mesh is considered herniorrhaphy.Although various surgical approaches have been developed,the surgical technique should be carefully chosen for each patient.Regarding as interesting history,crucial anatomy and important surgeries in the field of groin hernia,we here summarized them in detail,respectively.Points of debate are also reviewed;important points are shown using illustrations and schemas.We hope this systematic review is surgical guide for general surgeons including residents.Both a skillful technique and anatomical knowledge are indispensable for successful hernia surgery in the groin.
文摘Background: Laparoscopic hernioplasty has gained popularity with significant advances in prostheses. Omega-3 coating mesh (C-Qur) is a prosthesis that can be used in the abdominal cavity, and the coating prevents adhesion of the mesh to the viscera. We planned a prospective observational study of laparoscopic hernioplasty using C-Qur. Methods: C-Qur was used in laparoscopic hernioplasty over the course of 1 year. We considered laparoscopic approaches as our primary treatment method for abdominal wall hernias. Although only a single incision was made for the majority of the laparoscopic hernioplasties, additional incisions were made when severe adhesions were encountered. For incisional or ventral hernias, a lateral lower incision was made. For inguinal hernias, an umbilical incision was made. Sex, age, diagnosis, number of incisions, additional incisions, morbidity, and follow-up period were evaluated. Results: Twenty-four patients who underwent surgery between May 2010 and April 2011 were included in this study. The median follow-up period was 14 months. The most common early complications included wound pain and edema;however, there were no persistent complications.
文摘In order to compare the effects of Bassini and tension-free mesh hernioplasty,a total of 552 patients with inguinal hernia who were subjected to surgical treatment in our hospital were randomly divided into the following two groups:the Bassini group(n=269)and the tension-free mesh group(n=283).The recurrence rates,pain,dis-comfort,and other complications were recorded,and the causes of the complications were explored.The recurrence rate in the Bassini group was 8.9%(24/269),significantly higher than that in the tension-free repair group(2.8%,8/283).In addition,the recurrence rates in the Bassini and tension-free groups before 2004 were 12.6%and 5.6%,respectively,which were markedly higher than the rates after 2004(5.3%and 0.7%,respectively).The rate of post-operative discomfort and pain within thefirst three months was higher in the Bassini group compared to the tension-free group(25.7%vs 18.5%,respectively).However,there was no difference after three months in the rate of post-operative discomfort and pain,incidence of infection,or scrotal edema between the two groups.The average hospital stay in the Bassini group was longer than that in the tension-free repair group(7.6�1.2 vs 4.5�2.2 days,respectively),but the cost was lower(4518.0�510 vs 6221.3�578 yuan,respectively).Thus,tension-free mesh hernioplasty is indicated for most inguinal hernia patients due to the low recurrence rate,rapid recovery time,and treatment success,but the traditional Bassini procedure has lower cost and other beneficial effects and is still suitable for some patients.
文摘BACKGROUND A pelvic floor hernia is defined as a pelvic floor defect through which the intraabdominal viscera may protrude.It is an infrequent complication following abdominoperineal surgeries.This type of hernia requires surgical repair by conventional or reconstructive techniques.The main treatments could be transabdominal,transperineal or a combination.CASE SUMMARY In this article,we present the case of a recurrent perineal incisional hernia,postresection of the left side of the pelvis,testis and lower limbs resulting from a mine disaster 18 years ago.Combined laparoscopic surgery with a perineal approach was performed.The pelvic floor defect was repaired by a biological mesh and one pedicle skin flap.No signs of recurrence were indicated during the 2 years of follow-up.CONCLUSION The combination of laparoscopic surgery with a perineal approach was effective.The use of the biological mesh and pedicle skin flap to restructure the pelvic floor was effective.
文摘Background: The mechanism of the development of acquired inguinal hernia, especially indirect inguinal hernia, is not well known. Although anatomical studies have been performed to explain development of inguinal hernia, they have mainly involved autopsy or temporal findings at the time of hernioplasty. To elucidate the pattern of development of acquired inguinal hernia, we studied the occurrence of inguinal hernia after robotic-assisted laparoscopic prostatectomy (RALP). Methods: From March 2009 to November 2011, RALP for prostatic cancer was performed on 60 patients in our institute. The RALP was performed by one urologist using the da Vinci Surgical System. The postsurgical development of inguinal hernia was diagnosed based on patients’ symptoms. Seven patients were treated with laparoscopic hernioplasty, and one underwent mesh-plug repair. Using video recordings, the laparoscopic findings during RALP and laparoscopic hernioplasty were compared among all patients. Results: Seven of 59 patients (11.9%) developed an inguinal hernia. One patient had a pre-existing pantaloon inguinal hernia at the time of RALP. Eleven inguinal lesions in the seven patients who underwent laparoscopic hernioplasty were reviewed, and all were indirect inguinal hernias. Conclusion: A main factor in the development of inguinal hernia after RALP could be a combination of outer-side intact layers and inner-side hard scar of the inguinal ring, which seems like “out swing door”.
