Objective To investigate the effect of distal high ligation of hernial sac closed on the prevention of postoperative scrotum seroma of totally laparoscopic extraperitoneal inguinal hernia repair. Methods The clinical data of 84 male patients who performed laparoscopic total extraperitoneal inguinal hernia repair from May 2014 to May 2015 May were analyzed. They were randomly divided into two groups: block group (42 patients with distal hernia sac ligation closed), and non-block group (42 patients with distal hernia completely stripped off or exclusion). The rate of scrotum seroma, operation time, postoperative infection, length of stay and follow-up status were compared between two groups. Results All the surgery completed successfully. The operation time and length of stay in two groups had no significant differences (P>0.05). No patients used analgesics, and no patients had postoperative infection and hematoma. The rate of scrotum seroma in block group was significantly lower than that in non-block group: 0 vs. 11.9%(5/42), P<0.05. They were followed up for 5- 17 months, with average 11.2 months, and there was no chronic pain patients. Conclusions The distal high ligation of hernial sac closed in the prevention of postoperative scrotum seroma of totally laparoscopic extraperitoneal inguinal hernia repair is effect.

Objective To evaluate the value of bypass graft in the treatment of critical lower limb ischemia with distal single outflow artery.Methods Forty-nine lower limbs in 42 patients with single outflow artery were collected and underwent arterial bypass graft.The operation methods included femoropopliteal artificial graft to single outflow artery with autograftand popliteal artery to calf vessel and so on.The results were analyzed finally.Results All of 42 patients,postoperative grafts occlusion occured in 1 case,the occlusion rate was 2.4％(1/42) and the success rate was 97.6％(41/42),1 case died of respiratory failure 4 d postoperatively,the mortality was 2.4％(1/42).The patency rate of graft was 100.0％(41/41) on discharge.Healing rate of foot ulcer was 33.3％ (11/33).Conclusions It's difficult to reconstruct blood flow for critical ischemic limb with single outflow artery,but good result is still expected by distal lower limb bypass graft.Distal bypass can provide a better nutritional support for the healing of foot ulcer and result in a lower limb salvage or lowering of amputation level.

Laparoscopic pancreaticoduodenectomy (LPD) is technically safe and feasible with advantage of minimally invasive feature, and has become a routine procedure in some minimally invasive pancreatic centers. However, LPD is complicated to be operated and will take a long time to operate proficiently. How to successfully promote LPD application has become a key issue in the new era. This article focuses on the key issues in how to promote LPD application safely in primary hospitals, whether LPD can be used for malignant tumors, and how to cultivate new generation LPD experts.