Objective To compare the efficacy and safety of transabdominal preperitoneal hernia repair (TAPP) and open tension-free inguinal hernia repair (Lichtenstein technique) for inguinal hernia after liver and kidney transplantation. Methods A retrospective analysis was conducted on data of 17 patients with inguinal hernia after liver and kidney transplantation. According to the surgical methods, 14 patients with TAPP were assigned to experimental group 1, and 20 patients without a history of organ transplantation during the same period were assigned to control group 1. Additionally, 3 patients with the Lichtenstein technique were assigned to experimental group 2, and 10 patients without a history of organ transplantation during the same period were assigned to control group 2. Statistical analysis was performed to compare operation time, blood loss, and postoperative recovery, and to analyze the impacts of different organ transplantation on surgical method selection. Results The operation time in experimental group 1 was (50.17±14.52) minutes, which was significantly longer than (33.77±10.19) minutes in the control group 1 (P < 0.05). No significant differences were observed between the two groups in terms of blood loss, postoperative ambulation time, and hospital discharge time (P>0.05). In experimental group 2, the operation time was (41.87±12.55) minutes and the blood loss was (10.78±7.56) mL, which was significantly longer than (27.14±10.64) minutes and higher than (5.40±1.56) mL in control group 2 (P < 0.05). There were significant differences in surgical blood loss and hospital discharge time between experimental group 1 and experimental group 2 (P < 0.05). Conclusion TAPP can improve surgical outcomes and safety, and reduce occurrence of complications. For patients with inguinal hernia after kidney transplantation combined with ureteral transplantation, the Lichtenstein technique is safer.

Objective:To explore the effect of excessive visceral fat area (VFA) on the intraoperative risk and postoperative outcome of laparoscopic-assisted distal gastric cancer surgery (LADG).Methods:A retrospective selection of 82 patients who underwent LADG at the Department of General Surgery, Beijing Friendship Hospital, Capital Medical University from June 2017 to March 2018 was selected. The patients were divided into two groups according to the VFA value calculated by preoperative CT: high VFA group ( n=31) and the low VFA group ( n=51). Patients in the high-VFA group had VFA≥100 cm 2, and those in the low-VFA group had VFA<100 cm 2. The differences in operation time, blood loss, number of lymph node dissections, and postoperative complications (including intestinal obstruction, anastomotic fistula, pancreatic fistula, and abdominal infection) were statistically compared between the two groups. Measurement data were expressed as mean±standard deviation ( Mean± SD), comparison between groups was by t-test; comparison of count data between groups was by Chi-square test. The factors related to pancreatic fistula were tested by one-way variance test, and the factors with differences were entered into the multivariate Logistic regression analysis as independent variables. Results:In terms of surgical bleeding ( P=0.061), lymph node dissection ( P=0.089), postoperative anastomotic leakage ( P=0.210), intestinal obstruction ( P=0.275) and abdominal infection ( P=0.130), the comparison between the two groups showed no significant statistical difference ( P>0.05), but compared with the low VFA group, the operation time of the high VFA group was prolonged [(258±91)min vs (230±82)min, P=0.018], and the onset of pancreatic fistula rate was significantly higher (11/31 vs 3/51, P=0.001), and there was statistical significance between the two groups ( P<0.05). The results of univariate analysis showed that gender and VFA were risk factors for pancreatic fistula; the results of multivariate analysis showed that VFA was a predictor of pancreatic fistula. Conclusion:Excessive VFA prolongs LADG operation time and is more valuable in predicting the occurrence of postoperative pancreatic fistula.