Currently,the number of abdominal surgery has gradually increased,accompanied by the increasing of ventral hernia and parastomal hernia patients.The main reason is abdominal incision or abdominal stoma destroying the normal abdominal muscle fascia,as well as obesity,malnutrition,ascites,diabetes,infections leading to poor wound healing.The incidence of abdominal wall incisional hernia after abdominal surgery accounts for about 80％ of ventral hernia.These incisional hernias and some other ventral hernias may easily become large ventral hernia without the standard treatment.Surgery is the only effective treatment for large ventral hernia.However,such hernia repair for surgeons is a great challenge.In clinical practice,after removing the huge sac and completely resetting the contents of the hernia sac can lead to decreasing of intraperitoneal volume and increasing of intra-abdominal pressure,or even lead to occurrence of abdominal compartment syndrome (ACS).The increasing of intra-abdominal pressure and occurrence of ACS has aroused the attention of clinicians after large ventral hernia operation.Some content reduction operation in the process of large ventral hernia surgery can effectively reduce postoperative intra-abdominal pressure,occurrence of intra-abdominal hypertension and ACS.More and more patients with large ventral hernia underwent the abdominal content reduction surgery combined with hernia repair.But there is still lack of evidencebased medical researches on large simples.Therefore,it still needs multi-center prospective clinical study on large samples to provide clinical treatment strategies for the volume reduction surgery and more base for further researches and clinical applications.

Objective To discuss the control of ascites, timing and skill of herniorrhaphy for the treatment of umbilical hernia with ascites. Methods The management of 21 patients of umbilical hernia with ascites were retrospectively analyzed. Preoperative small amount of ascites was managed with oral diuretics, medium amount of ascites was treated with combined oral and intravenous diuretics, refractory ascites was treated with paracentensis (3000 ml each time). In the meantime, intravenous albumin, dopamine and fluid therapy were administered. In relapsing ascites, repeated paracentensis in a time interval of 2-4 days was applied. It was time for surgery when abdominal wall tension ameliorated, abdominal circumference reduced and the hernia sac shrank. In case of ascites refractory to all preoperative management an intraoperative slow extraction of the ascites to the amount below 4000 mi is mandatory. Perioperative diuretic therapy is the key for a successful herniorrhaphy. There were 21 cases in our group, 19 cases underwent selective operation, 2 cases were treated with emergency operation; 20 cases by tension-free hernia repair, 1 case by suture herniorrhaphy. Results Surgery was successful in all patients, the mean operative time was 45 min (25-90 min). During the follow-up period from 2 to 52 months (meanly 23 months), only 1 case lost and the other 19 cases healed with no recurrence. 20 patients healed well with no hernia recurrence or complications. One case who was treated with suture hemiorrhaphy suffered from incisional infection, and died of hepatic failure 3 weeks after surgery. Conclusions Umbilical hernia with ascites is not an absolute surgical contraindication. By intensive management of the ascites in perioperative period and prudent selection of the timing of surgery, tension-free herniorrhaphy is a safe and effective treatment for umbilical hernia.

Objective To evaluate the effect of lightweight polypropylene mesh in tension-free repair of inguinal hernia.Methods A total of 60 patients were divided into 2 groups to receive lightweight polypropylene mesh(experimental group)or standard polypropylene mesh(control group)repair procedures.Data collected included:operation time,postoperative highest temperature and the length of hospital stay;leucocyte count and differential count,CRP,AST,ALT,BUN,Cr at the first day preoperatively and postoperatively.Postoperative complications including wound infection,hernia recurrence,testicular swelling or atrophy,scrotal hydrocele,chronic pain and foreign body feeling were compared with each other.Data were analyzed by statistical method.Results No significant differences were found between the two groups in the operation time,postoperative highest temperature,postoperative hospital stay,and cases of elevated postoperative CRP(c-reactive protein)level.No significant differences were found in the leucocyte count,differential count,and AST,ALT,BUN,Cr level perioperatively between the two groups.During the follow up period of 12～16 months,there was no wound infection,hernia recurrence,testicular swelling or atrophy in the two groups;There were 2 cases of scrotal hydrocele and 1 case of postoperative chronic pain in experimental group,there were 3 cases of scrotal hydrocele and 3 cases of postoperative chronic pain in control group;Six patients complained of foreign body feeling in control group,but no one in experiment group,the difference was statistically significant(P＜0.05).Conclusions Lightweight polypropylene mesh in tension-free herniorrhaphy is safe and effective.It ameliorates postoperative foreign body feeling thanks to the feature of light weight,high porosity and excellent flexibility.

Hernia is ancient and common.With the emerging of new concepts,techniques,materials and equipments,treatment methods of hernia have undergone ever-changing changes in the 21st century.Hernia and abdominal wall surgery in China has been developing fast in the past 20 years,and has achieved remarkable progress.However,some problems still exist,such as unbalanced regional development,concept misunderstanding,classification confusions,less standardized technology,poor follow-up method,lack of innovation,and so on.Therefore,it's crucial to recognize the shortcomings of the current stagey,discuss the existing problems,sum up experiences and lessons,and clarify the direction of improvement,in order to provide a solid foundation for the sustainable development of hernia and abdominal surgery for our country.

Objective To investigate the analgesic effect of lidocaine plus ropivacaine in inguinal hernia tension-free repair under local anesthesia.Methods A total of 815 patients with unilateral inguinal hernia admitted to Chaoyang Hospital from July 2013 to Jane 2014 were enrolled in this retrospective study.The patients were divided into 2 groups:local anesthesia using a combination of 1％ lidocaine (l0 ml) and 0.75％ ropivacaine (10 ml) in observation group (n =412),and 1％ lidocaine (20 ml) were administered in control group (n =403).Postoperatively heart rate (HR),mean arterial pressure (MAP),pain intensity (VAS),analgesic demand,adverse events and hospital duration were assessed.Results There was no significant difference between the 2 groups in postoperative hemodynamic monitoring (all P ＞ 0.05).VAS score in observation group were lower than those in control group at 1,3,6 and 9 h.The former needed significantly less pain killer (all P ＜ 0.05).Conclusion Ropivacaine decreases postoperative pain level after tension-free inguinal hernia repair without additional risk of perioperative events.

Objective To evaluate medical chemistry adhesive in tension-free herniorrhaphy for inguinal hernia. Methods In this study, 100 patients with primary unilateral inguinal hernia were assigned to study group ( n = 50) and control group ( n = 50) during Jun. 2009 and Dec. 2009. Medical chemistry adhesive (n-butyl-2-cyanoacrylate, NBCA) was used in Lichtenstein tension-free hernia repair in study group and suture procedure was used in control group. Patient demographics, operation time,postoperative length of stay, visual analogue scale ( VAS ) score 24 hours after surgery, incidence of postoperative chronic pain and hematoma, recurrence rate, and other complications were compared between the two groups. Results The duration of follow-up ranged from 12 months to 18 months. There were no recurrences or wound infection in the two groups. In study group, no patient complained of chronic pain postoperatively, whereas in the control group, 6 patients ( 12% ) had a significant chronic pain. In study group, 2 patients (4%) had local hematoma after operation, whereas there were 8 ( 16% ) in the control group ( P ＜ 0. 05 ). There were no significant differences between the 2 groups in postoperative length of stay ( P ＞ 0. 05 ), but the operation time and postoperative VAS score in study group ( 38 ± 5 min and 2. 5 ± 0. 6)were lower than in the control group (42 ± 5 min and 2. 8 ± 0. 8 ), ( P ＜ 0. 05 ). Conclusions Application of medical chemistry adhesive in tension-free herniorrhaphy for inguinal hernia is associated with less postoperative pain, lower incidence of hematoma, less postoperative chronic pain and shorter operation time.

Objective To study the application of Polypropylene-Prolene Hernia System ( PHS) in tension-free herniorrhaphy of femoral hernia. Methods A total of 36 patients with femoral hernia were randomly divided into 2 groups to receive respectively PHS or Plug repair procedure. Data collected included; operative time, hospital stay, postoperative complications and recurrence rate. Results In PHS and Plug groups, the operative time were (42?7) min and (41?4) min respectively, the hospital stay was (4. 1?1. 0) d and (4.4?1. 2) d respectively. During the follow up period from 6 to 30 months,there was no recurrence, one case of scrotal hydrocele in PHS group, and there were two cases of recurrence and one case of ecchymoma in Plug group. Five patients complained of foreign body feeling in Plug group, and no patient in PHS group ( P

Objective To evaluate the choices and surgical skills for tension-free femoral hernia repair under local anesthesia. Methods The clinical data of 109 nonincarcerated femoral hernia patients were summarized from December 2002 to December 2009. Patients were divided into 3 groups according the time period at which the surgery was performed. 85 patients from 2002 to 2008 were divided into 2 groups,45 cases treated with preperitoneal repair ( preperitoneal group), and the other 40 cases with mesh-plug repair (plug group). The 24 cases admitted from January 2009 to December 2009 received modified preperitoneal repair. Operation time, VAS, length of hospitalization, incidence of recurrence, foreign body feelings and seroma were compared among the three groups. Results All the 109 patients were repaired under local anesthesia, and there was no perioperative death. The statistical indicator value of incidence of recurrence, foreign body sensation and seroma in preperitoneal group was lower than plug group (P ＜0.05). The modified preperitoneal repair was better in operation time, VAS, length of hospitalization than preperitoneal group (P ＜ 0.05). Conclusions Modified preperitoneal repair under local anesthesia is the choice for treating femoral hernia without incarceration. Modified preperitoneal repair is faster, more minimally invasive and faster recovery.

Objective To explore the clinical efficacy of posterior component separation (PCS) with Sublay mesh repair for complex abdominal incisional hernia.Methods The retrospective cross-sectional study was conducted.The clinical data of 30 patients with complex abdominal incisional hernia who were admitted to the Beijing Chao-Yang Hospital of Capital Medical University from July 2016 to March 2017 were collected.Patients intraoperatively received PCS with Sublay mesh repair.Observation indicators:(1) intra-and post-operative situations:defect area of incisional hernia,operation time,volume of intraoperative blood loss,time of postoperative drainage-tube removal,postoperative complications and duration of postoperative hospital stay;(2) follow-up situation.Follow-up using outpatient examination and telephone interview was performed to detect recurrence of hernia and mesh-related complications up to July 2017.Outpatient examination was done once at postoperative month 1,3 and 6 and telephone interview was done at 1 year postoperatively.Measurement data with normal distribution were represented as x±s and measurement data with skewed distribution were described as M (range).Results (1) Intra-and post-operative situations:30 patients received successful PCS with Sublay mesh repair for complex abdominal incisional hernia.Defect area of incisional hernia,operation time,volume of intraoperative blood loss and time of postoperative drainage tube removal were respectively (222± 124)cm2,100 minutes (range,40-235 minutes),80 mL (range,50-200 mL) and 5 days (range,2-15 days).Of 7 patients with postoperative complications,3 were complicated with shallow surgical site infection,including 1 with wound healing by vacuum sealing drainage and 2 with delayed healing by debridement and drainage;2 with postoperative seroma were improved by aspiration and local pressurization after 1 months;1 with fat liquefaction of abdominal incision was improved by symptomatic treatment;1 with postoperative active hemorrhage was confirmed with arteriolar hemorrhage of muscular layer and then received hemostasis by ligation.Time of postoperative hospital stay of 30 patients was 15 days (range,10-57 days).(2) Follow-up situation:30 patients were followed up for (7± 3) months,without occurrences of hernia recurrence,intestinal fistula and mesh-related complications.Conclusion PCS with Sublay mesh repair for complex abdominal incisional hernia is safe and feasible,with good clinical efficacies.

Objective To sum up the experience of performing a laparoscope-assisted hemiorrhaphy for huge ventral hernia through small incision.Methods Clinical data were retrospectively analyzed for 18 cases of huge ventral hernia admitted from Jan 2009 to Sept 2009 undergoing laparoscope- assisted hernia mpair through small incision.Data renewed including the operational duration,missed hernia,length of the incision,serumal cyst,the length of hospital stay,chronic pain and the recidivation.Results Surgery was successful in all of the 18 cases,the operational time was(129±19) main,the length of the incision was(5.6±1.0) cm.Missed hemia were identified in 3 cases during the operation.One case:suffered from postoperative serumal cyst,the postoperative length of hospital stay was(5.1±1.2) days,postoperative incisional pain lasting for more than 3 months was identified in 1 case,there was no incisional infection and nor injury to intraabdominal organs,there was no operative mortahty,all the cases were followed-up for(8.6 ±1.6)months and there was no recidivation.Conclusions The laparoscope hemia repair with the subsidiary of micro-incision is effective and safe,and it reshapes the abdominal wall.