Child ; Hernia, Inguinal ; surgery ; Herniorrhaphy ; methods ; Humans ; Laparoscopy ; methods

OBJECTIVETo explore the feasibility of single-incision laparoscopic totally extraperitoneal hernioplasty (SILS-TEP) with self-made port for repairing of inguinal hernia.

METHODSSILS-TEP was performed in 7 inguinal hernia patients (9 sides) with conventional laparoscopic instruments and self-made port, which composed of a wound retractor, surgical gloves and 3 ordinary trocars. The clinical data and follow-up results of 7 cases were retrospectively collected and analyzed.

RESULTSThe self-made port was applied for SILS-TEP uneventfully without the need of additional ports in all 7 patients (9 inguinal hernias). The median operating time was 90. 0 (70-125) min, intraoperative blood loss was 10. 0 (5. 0-20. 0) mL and postoperative hospital stay was 2.0 (2. 0-4. 0) d. The median pain scores of visual analog scale (VAS) at 6 h,12 h, 24 h and 14 d were 3(2~4), 2(1~2), 1(0~2) and 0(0~1), respectively. There were no intraoperative complications reported, and all patients were satisfied with wound healing. No hernia recurrence was observed during the 3-months of follow-up.

CONCLUSIONOur initial experiences show that SILS-TEP with self-made port is a safe and feasible surgery, which can simplify the procedure with available equipments and reduce the cost, therefore can be applied in grass-root hospitals.

Hernia, Inguinal ; surgery ; Herniorrhaphy ; methods ; Humans ; Laparoscopy ; methods ; Length of Stay ; Retrospective Studies

Parastomal hernia is a common complication after abdominal ostomy. Although the European Hernia Society guidelines recommend surgical treatment for parastomal hernia, there is still no "gold standard" procedure. The exploration and practice of parastomal hernia repair surgery has been carried out for many years, from the earlier hernia ring suture and stoma relocation repair, to the reinforcement of meshes (such as the Keyhole repair technique and the Sugarbaker repair technique) and the application of laparoscopic technique, and then to the combination of various methods. The intervention of single-port laparoscopic technique and robot-assisted surgery, the prevention of parastomal hernia, the specialization of treatment, multidisciplinary cooperation, and the improvement of diagnostic methods will all provide more optimal solutions for stoma patients. This article will review and summarize the development process and evaluation of parastomal hernia surgical techniques.
Humans ; Herniorrhaphy/methods* ; Surgical Mesh ; Incisional Hernia/surgery* ; Surgical Stomas/adverse effects* ; Laparoscopy/methods*

OBJECTIVETo discuss clinical effects and methods of mini-incision posterior laminectomy by fenestration in the treatment of huge lumbar disc herniation.

METHODSFrom 1999 to 2008,107 patients with huge protruded lumbar intervertebral disc were retrospectively analyzed including 78 males and 29 females with an average age of 38.5 years ranging from 26 to 59 years. The patients were operated with mini-incision posterior laminectomy by fenestration. The affected region of patients were L4.5 (36 cases), L5S1 (71 cases). The herniation rate of nucleus was more than 40%. The patient's scores based on low back pain improved JOA standard were retrospectively analyzed.

RESULTSThe 107 patients were followed-up for from 0.5 to 4 years with an average of 1.75 years. The scores by low back pain improved JOA standard were improved from (1.500 +/- 1.200) before operation to (12.700 +/- 0.950) after operation. The average improvement rate was (82.96 +/- 6.85)%.

CONCLUSIONIt is a reliable method in the treatment of huge lumbar disc herniation with mini-incision posterior laminectomy by fenestration. The treatment method have advantage with less trauma, good spinal stability, conducive to patient recovery and maintain clinical efficacy.

Adult ; Female ; Herniorrhaphy ; Humans ; Intervertebral Disc Displacement ; surgery ; Laminectomy ; methods ; Lumbar Vertebrae ; Male ; Middle Aged ; Prognosis

OBJECTIVETo investigate the regional anatomy of the inguinal region and abdominal ring and provide accurate anatomic basis for the clinical application of total peritoneum intraperitoneal onlay mesh (TPIPOM).

METHODSThe structures of the inguinal region and those surrounding the abdominal ring of 18 cadavers (11 males and 7 females, 36 sides) were dissected to measure the lengths from the nerves and vessels to the corresponding anatomical landmarks.

RESULTSThe average distances from the point where the iliohypogastric nerve (IHN) ran through the obliquus internus abdominis to anterosuperior iliac spine and from the point where the IHN ran through the aponeurosis of the external oblique muscle of the abdomen to the superior margin of the symphysis pubica were 4.10±0.89 cm and 5.02±1.46 cm, respectively. The average distances from the point where the ilioinguinal nerve (IGN) ran through the obliquus internus abdominis to the anterosuperior iliac spine and from the point where IGN ran through the aponeurosis of the external oblique muscle of the abdomen to the superior surface of the tuberculum pubicum were 3.09±0.81 cm and 3.84±0.89 cm, respectively. We established the regional anatomy model of the structures surrounding the abdominal ring.

CONCLUSIONThe quantitative measurement of important structures of the inguinal region and establishment of the regional anatomy model of the surrounding structures of the abdominal ring can provide a valuable reference to reduce intraoperative and postoperative complications of TPIPOM.

Female ; Groin ; anatomy & histology ; Hernia, Inguinal ; surgery ; Herniorrhaphy ; methods ; Humans ; Laparoscopy ; Male

Complex ventral hernia refers to a large hernia that is complicated by a series of concurrent conditions. Change in intra-abdominal pressure is one of the main pathways through which various factors exert an impact on perioperative risk and postoperative recurrence. Taking abdominal pressure reconstruction as the core, the treatment strategy for complex abdominal hernia can be formulated from three aspects: improving patients' tolerance, expanding abdominal cavity volume, and reducing the volume of abdominal contents. Improving patients' tolerance includes abdominal wall compliance training and progressive preoperative pneumoperitoneum. To expand the volume of the abdominal cavity, implanting hernia repair materials, component separation technique, autologous tissue transplantation, component expend technique, and chemical component separation can be used. Initiative content reduction surgery and temporary abdominal closure may be performed to reduce the volume of abdominal contents. For different cases of complex ventral hernia, personalized treatment measures can be safely and feasibly adopted depending on the condition of the patients and the intra-abdominal pressure situation.
Humans ; Hernia, Ventral/surgery* ; Abdominal Wall/surgery* ; Plastic Surgery Procedures ; Herniorrhaphy/methods* ; Surgical Mesh ; Recurrence

With the development of modern surgery, the field of hernia and abdominal wall surgery is undergoing a transformative change, and new techniques, new concepts, and recent progress are being updated, which have motivated the high-quality development of the discipline. In the past two decades, the development of hernia and abdominal wall surgery in China has been recognized by international peers. Many young surgeons have gradually become the main force in the treatment of hernia and leaders in surgical technique. The innovation and development of discipline will never terminate; young surgeons as the main force should seriously think about how to improve their professional qualities. Young surgeons are interested in the innovation of surgical techniques and need to push for a traditional operation on the one hand and an innovative operation on the other. Updates to concepts and acquisition of new materials are more important, which can provide a solid foundation for technological innovation. Young surgeons should start with the basics and classics. Understanding the history and development of new techniques, new concepts and recent progress, and grasping indications of clinical application, is the important part of growing up for young surgeons, which can make surgical treatment more standardized, benefit patients, and promote the progress of Chinese specialized medical education.
Humans ; Abdominal Wall/surgery* ; Hernia ; Surgeons ; Herniorrhaphy/methods* ; China ; Surgical Mesh

Objective: To analyze the short-term clinical effects of robot-assisted and laparoscopic repair of the hiatal hernia. Methods: The clinical data of 56 patients underwent minimally invasive hiatal hernia repair from January 2021 to January 2022 in the Department of Minimally Invasive Surgery, Hernias and Abdominal Wall Surgery, People's Hospital of Xinjiang Uygur Autonomous Region were retrospectively analyzed. There were 32 males and 24 females, aging (59.7±10.7) years (range: 28 to 75 years). All patients were divided into laparoscopy group (n=27) and robot group (n=29) according to surgical procedures. Perioperative conditions, hospital stay, and improvement in symptoms before and after surgery were compared between the two groups by the t test, Wilcoxon rank-sum test and χ² test. Results: All surgical procedures were successfully completed, without conversion to laparotomy or change in operation mode. There were no serious complications related to the operation. The intraoperative blood loss of the robot group was less than that of the laparoscopic group (M (IQR)): (20 (110) ml vs. 40 (80) ml, Z=-4.098, P<0.01). The operation time ((111.7±33.6) minutes vs. (120.4±35.0) minutes, t=-0.943, P=0.350) and hospitalization time ((3.9±1.4) days vs. (4.7±1.9) days, t=-1.980, P=0.053) of the robot group and the laparoscopic group were similar. Follow-up for 12 months after the operation showed no postoperative complications and recurrence. The score of the health-related quality of life questionnaire for gastroesophageal reflux disease in the robot group decreased from 10.8±2.8 before the operation to 6.5±0.6 after the operation, and that in the laparoscopic group decreased from 10.6±2.1 before the operation to 6.3±0.6 after the operation. There was no difference in the influence of different surgical methods on the change in score (t=0.030,P=0.976). Conclusion: Compared with laparoscopic repair of the hiatal hernia, robot-assisted hiatal hernia repair has the advantages of less bleeding, rapid postoperative recovery and good short-term effect.
Male ; Female ; Humans ; Hernia, Hiatal/complications* ; Retrospective Studies ; Robotics ; Herniorrhaphy/methods* ; Quality of Life ; Laparoscopy/methods* ; Recurrence ; Fundoplication/methods*

Objective: To analyze the recurrence factors and reoperation effect of laparoscopic inguinal hernia repair. Methods: A total of 41 patients with recurrence after laparoscopic repair of the inguinal hernia admitted to the Department of Hernia and Abdominal Wall Surgery, Beijing Chaoyang Hospital Affiliated to Capital Medical University from January 2017 to December 2021 were retrospectively analyzed. All patients were males, aging (62±7) years (range: 51 to 75 years). The recurrence intervals were 3 days to 7 years postoperatively. The surgical methods, causes of recurrence, and treatment outcomes of the patients were analyzed. Fisher exact probability method is used to compare the rates. Results: Among all cases, the primary surgical procedures included transabdominal preperitoneal herniorrhaphy (TAPP) in 31 cases and total extraperitoneal herniorrhaphy in 10 cases. The reoperative procedures included the TAPP of 11 cases and the Lichtenstein procedure of 30 cases. The factors of recurrent cases in all patients could be divided into 4 categories, including insufficient mesh coverage in 23 cases, mesh curling in 9 cases, mesh contractuture in 7 cases, and improper mesh fixation in 2 cases. Recurrence, infection, chronic pain, foreign body sensation didn't occur in the followed period of(M(IQR)) 18(24) months(range: 12 to 50 months). There was no statistical difference in the incidence of postoperative seroma between the TAPP and Lichtenstein procedure (3/11 vs. 20.0% (6/30), P=0.68). Conclusions: Postoperative recurrence of laparoscopic inguinal hernia is mostly caused by the lack of mesh coverage. Due to the emphasis on standardized surgical operation, a good outcome could be achieved through reoperation by the TAPP or Lichtenstein procedure.
Male ; Humans ; Female ; Hernia, Inguinal/surgery* ; Retrospective Studies ; Laparoscopy/methods* ; Treatment Outcome ; Postoperative Complications/epidemiology* ; Herniorrhaphy/methods* ; Surgical Mesh ; Recurrence

OBJECTIVETo evaluate the safety and efficacy of hernioplasty using acellular tissue matrix patch to repair inguinal hernia of pediatric patients aged 6 to 18 years.

METHODSSixty eligible patients aged 6 to 18 years with primary unilateral inguinal hernia were randomly assigned to experimental or control group from June to December 2009. In the experimental group, acellular tissue matrix patch was used during Lichtenstein herniorrhaphy while traditional high ligation of hernial sac was used in the control group. Preoperative and postoperative parameters such as clinical informations of patients, postoperative complications and recurrence rate were recorded and analyzed.

RESULTSThere were no significant differences between the 2 groups in postoperative length of stay [(31 ± 8) h vs. (34 ± 11) h] and postoperative Visual Analogue Scale Pain Score (2.8 ± 0.9 vs. 2.6 ± 1.0) (P > 0.05), but the operation time in the experimental group were longer than that in the control group significantly [(39 ± 4) min vs. (36 ± 4) min, t = 3.357, P = 0.001]. The duration of follow-up ranged from 14 to 20 months. There were no postoperative incisional infection, chronic postoperative pain and local foreign body sensation in two groups. In the experimental group, 3 patients suffered scrotal hydrocele as compared 2 patients in the control group. There was no recurrence in the experimental group as compared 2 patients (6.7%) in the control group, which was no significant difference (P > 0.05).

CONCLUSIONLichtenstein repair for pediatric patients aged 6 to 18 years with acellular tissue matrix patch has good results and with limited postoperative complications.

Acellular Dermis ; Adolescent ; Child ; Female ; Hernia, Inguinal ; surgery ; Herniorrhaphy ; instrumentation ; methods ; Humans ; Male ; Surgical Mesh ; Treatment Outcome