Objective To evaluate hernia repair with Onlay (premuscular positioning of the prosthesis) for the treatment of parastomal hernia.Methods In this study 45 patients with parastomal hernia were treated with a tension-free manner of hernia repair in situ by Onlay using prolene mesh between February 2006 and April 2012.There were 24 males and 21 female cases,including 6 recurrent parastomal hernia cases.The average age was (49 ±8) years ranging from 43 to 80.The parastomal defect ranged from 4 cm to 9 cm.Results All operations were successful.There was no hospital death or severe postoperative complications.The mean operating time was (109 ± 23) min (96-148),and the average time of pulling out the gastrointestinal decompression tube was (2.0 ± 2.0) day (12 h-3 d) and the drainage tube was removed after (5.0 ± 2.0) days (4-9 d).The mean postoperative hospitalization was (11 ± 3) days (9-16 d).42 cases achieved primary healing.The serofluid swelling in 7 cases was cured by puncturing and pressing the incision.41 cases were followed-up from 8 to 48 months,and 4 patients suffered from hernia recurrence respestively after 3 months,4 months,4.5 months and 7 months.One recurrent case was healed by conservative therapy and the other three were healed by reoperation.Conclusions Hernia repair in situ with Onlay method for parastomal hernia with prolene mesh was a safe and effective.

Objective To compare the clinical efficacy between reformed laparoscopic-assisted vaginal hysterectomy with sutureless of cardinal and uterosacral ligament(LAVH)and trans abdominal hysterectomy(TAH)for large uterus.Methods A retrospective study was performed using 106 reformed LAVH patients(observation group)and 100 TAH patients(control group)whose uterus were big(≥ 12weeks of gestation),the information was observed in perioperative period.Results Anal exsufflation time,hospitalization time after operation and postoperative pain time in observation group[(25.4 ± 3.3)h,(6.5 ±1.5)d,(16.9 ± 2.4)h]were significantly shorter than those in control group[(42.4 ± 5.3)h,(8.5 ± 1.5)d,(30.6 ± 5.3)h](P ＜ 0.05),the rate of complication in observation group[5.7％(6/106)]waa lower than that in control group[10.0％(10/100)](P＜ 0.05).Conclusion As to large uterus,reformed LAVH has several advantages over TAH,the technique is easy to learn,operation time is short,and the rate of complication is low.