Inguinal Herniorrhaphy: Complications and Recurrences.

Aim: Open repair of parastomal hernias is associated with high rates of morbidity and recurrence. A basic principle is the necessity of mesh-based techniques. The aim of this report was to review our department`s experience and evaluate a laparoscopic repair of parastomal hernia, primarily based on the intraperitoneal onlay mesh technique.Materials and Methods: A 77-year-old female was admitted to our institution with a two-year history of parastomal hernia. She had undergone abdominoperineal rectal extirpation for rectal cancer seven years before. CT scan of the abdomen and pelvis was performed before surgery and there was no evidence of cancer recurrence. Laparoscopic repair of the hernia with mesh was performed in this case.Results: A piece of COVIDIEN Parietex Composite Parastomal Mesh with a central keyhole and a radial incision was fastened laparoscopically over the colostomy and the hernia defect with a wide overlap, without dissecting out the sac. The mesh was secured to the margins of the hernia with circumferential tacking. The postoperative course was benign, without complications and she was dismissed from the hospital on the 4th postoperative day. Six months after surgery, there was no recurrence of the hernia.Conclusions: This case demonstrated that laparoscopic repair of parastomal hernia had good results and was a feasible and safe procedure for repairing this difficult problem.

Objective To evaluate clinical efficacy of the laparoscopic total extraperitoneal inguinal herniorrhaphy in the treatment of primary unilateral inguinal hernia. Method From January 2014 to January 2017, 120 patients with primary unilateral indirect inguinal hernia treated in our hospital were analyzed retrospectively, According to the different operation methods, 120 patients were divided into two groups: minimally invasive operation group (n=60) and open operation group (n=60) . Patients in minimally invasive operation group were treated with total laparoscopic extraperitoneal inguinal hernia repair. Statistical analysis were performed by using SPSS18.0 software. Perioperative measurement data, such as operative index and VAS score were expressed as (±s), and were examined by using t test.The postoperative complication rate was analyzed by Chi-square test. A P value <0.05 was considered as statistically significant difference. Results The incidence of complications in the minimally invasive operation group was less than that in the open surgery group (P 0.05), The time of ambulation and hospital stay were shorter in the minimally invasive operation group than those in the open operation group (P<0.05); The VAS score of the minimally invasive surgery group was better than that of the open operation group (P<0.05). Conclusion Total laparoscopic extraperitoneal inguinal hernia repair was effective, should be further popularized in clinical application. Key words: Hernia, Inguinal; Laparoscopy; Midline Incision; Comparative Study

Background: Incisional hernia and primary ventral hernia are among the most common surgical problems that general surgeons face annually in the United States (U.S.). Over 2 million laparotomies are performed in the US and the subsequent incisional hernia rate is 3–20%. At our institution, over the last several years, one surgeon has been performing a unique repair of intermediate-sized hernias by combining open and laparoscopic approaches. We hypothesized that, through a minimal incision, lysis of adhesions and primary repair can be performed, which can then be buttressed with a laparoscopically placed mesh that provides a generous underlay reinforcement that cannot be achieved in open repair. Furthermore, this technique provides the additional benefit of apposition of the rectus muscles and decreased seroma formation compared to laparoscopic hernia repair. Methods: Patients that underwent ventral hernia repair with laparoscopic assistance at NYU Lutheran Medical Center between October of 2012 and January 2015 form this study population. Each patient’s demographic, intra-operative, and postoperative data were collected and analyzed. Patient demographics included gender, age, BMI, prior abdominal surgery, co morbidities, and anticoagulation use. Intra-operative data included defect size, mesh size, and operative time. Postoperative data included complications, length of hospitalization, re-currences, seroma formation, surgical site infections (SSI), and mesh explantation. The surgical technique was as follows: a minimal incision was used over the defect which was only big enough to allow dissection down to the hernia borders. The hernia was reduced and lysis of adhesions of surrounding tissue performed. The hernia was sized and a mesh chosen to provide at least 3 to 5 cm of underlay around the defect. A series of one to four stay sutures were placed in the midline of the mesh and the mesh was placed intra-corporeally. The defect was closed primarily using the Smead-Jones technique (in 17 of 19 patients) to provide a tension-free double layer closure. The abdomen was in-sufflated, the mesh visualized, fixed to the midline via the stay sutures, and tacked circumferentially. The subcutaneous tissue and the skin were closed with absorbable suture. Results: A total of 19 patients (12 females, 7 males) underwent the hybrid hernia repair from October 2012 through January 2015. Only 1 (5%) was admitted postoperatively due to severe underlying co morbidities. The average size of the hernia defect was 5.94 cm 2 (2.5–15 cm 2 ) with an average mesh size of 16×16 cm 2 (9×9–25×20 cm 2 ) being used. Average operative time was 153 minutes with a range of 69–281 minutes. One (5%) had an early (within the first three months post-surgery) recurrence of the hernia. One patient (5%) had an early superficial SSI noticed during the 1 week follow-up appointment and was treated with oral antibiotics. None of the patients required re-hospitalization. None of the patients developed any seroma or any deep tissue infections requiring mesh explantation. Fourteen (74%) of the 19 patients were reached via telephone for further follow-up. All 14 patients were satisfied with the results of their surgery with only 1 complaint of pre-existing gastritis unrelated to the surgery. All of the patients that were employed prior to the surgery were able to return to work post-operatively. None of the patients reported any residual incisional or back pain. Conclusions: Hybrid ventral hernia repair has the physiological benefit of fascial continuity by re-approximating the hernia edges. This technique also maximizes the benefit of laparoscopic repair while mini-mizing associated complications. Patients had no severe wound complications. This surgical technique resulted in a low recurrence rate, and minimal pain after the procedure, making the hybrid technique a safe alternative method when repairing intermediate sized ventral hernias.

Objective To compare the clinical efficacy of laparoscopic repair of laparoscopic transabdominal preperitoneal(TAPP) and Lichtenstein tension-free repair herniorrhaphy in the treatment of recurrent inguinal hernia in adults, and to explore the clinical advantages of TAPP in the treatment of recurrent inguinal hernia. Methods A retrospective analysis was conducted in 54 adult patients with recurrent inguinal hernia from December 2010 to January 2015.The patients were randomly divided into TAPP group and Lichtenstein group.The operation time, intraoperative bleeding volume, postoperative hospitalization time, cost of hospitalization, postoperative complications, early postoperative pain and the recurrence of hernia were compared between the two groups. Results All patients were successfully completed surgery.The operation time of TAPP group (47.2±9.4)min was significantly shorter than (73.1±10.4)min of Lichtenstein group (t=-2.503, P=0.034). The median amount of bleeding during operation of TAPP group was 40(15-110)ml, which was significantly less than 73(11-130)ml in Lichtenstein group (t=-6.018, P=0.000). Postoperative hospital stay of TAPP group[(6.5±1.4)d]was shorter than (8.2±1.6)d of the Lichtenstein group (t=-2.613, P=0.028). Early postoperative pain score of TAPP group[(1.8±1.2)points]was better than (2.9±1.4)points in Lichtenstein group (t=-7.006, P=0.000), the difference was statistically significant.However, the hospitalization cost of TAPP group[(8 842.8±415.2)yuan]was higher than (6 676.9±327.6)yuan of the Lichtenstein group, the difference was statistically significant(t=6.782, P<0.05). In TAPP group, 2 cases had complications after operation, which were less than 5 cases of Lichtenstein group.Postoperative follow up ranged from 6 to 48 months, 1 case of recurrence in Lichtenstein group, the recurrence rate was 3.8%.There was no recurrence in the TAPP group. Conclusion TAPP has the advantages of short operation time, less bleeding, rapid postoperative recovery, less postoperative pain and so on.It can be used as a recommended procedure for the treatment of recurrent inguinal hernia in adults. Key words: Hernia, inguinal; Laparoscopy; Transabdominal preperitioneal laparoscopic herniorrhaphy; Path tension-free hernioplasty; Recurrence

Objective To explore the efficacy and safety of laparoscopic repair of paraesophageal hiatus hernia in infants and children. Methods From July 2012 to August 2015, 41 boys and 25 girls underwent laparoscopic repair of paraesophageal hiatus hernias. The mean age was (26±10)(1-39) months and mean weigh (9.5±6.1)(3.2-16) kg. Upper gastrointestinal contrast radiography was performed. The clinical types were I (n=25), II (n=37), III (n=2) and recurrent hernia (n=1). And there were Toupet (270-degree) fundoplication (n=32) and Nissen fundoplication (n=34). Results All repairs were successful without recurrence or serious complications. The mean operative duration was 70 (48-230) min, the mean volume of blood loss <10 ml and the mean hospital stay of 11 days. An unrestricted diet resumed at 24-72 h The postoperative follow-up period was 1-37 months. Conclusions Both safe and feasible, laparoscopic repair of paraesophageal hiatus hernia is worthy of wider clinical applications. With greater experiences, the number of open hole may decrease from 4 to 3 holes. And its operative duration has no obvious difference with that of conventional laparotomy Key words: Hiatus hernia; Laparoscopy; Esophagus

Objective Study the clinical value of using laparoscopic treatment in the autologous tissue repair for curing children's indirect inguinal hernia. Method Review and analyze 190 children's indirect inguinal hernia cases cured by using laparoscopic high ligation of hernia sac and autologous tissue repair in the past 5 years. Out of them, 153 cases are unilateral indirect hernia and 37 cases bilateral indirect hernia.183 cases (including 11 recurrent hernia cases) are normal cases of oblique hernia and 7 are urgency cases of incarcerated oblique hernia. Results All 190 cases have successful operations. The average operation time for unilateral indirect hernia is 10 minutes.Forbilateralindirect hernia,it is 18 minutes.The average time of stay in hospital is 1 day and there is no complication occurred after operation. Follow-up visits have been carried out for all cases. The duration ranges from 6 months to 5 years and there are five recurrent cases.Conclusion It is effective to use laparoscopic treatment in the autologous tissue repair for curing children's indirect inguinal hernia. It has many advantages, such as short operation time, few operative damages and complications, low recurrence rate and quick recovery. The treatment can be applied to contra-lateral oblique inguinal hernia or bilateral inguinal hernia repairs. Key words: Laparoscopic Treatment; Autologous Tissue Repair; Internal Ring High Ligation; Indirect Inguinal Hernia

Conventional incisional hernia repair, even with a piece of mesh incorporated, has high recurrence and morbidity. Laparoscopic incisional hernia repair was reported in western countries to be a better alternative. The purpose of this study is to report the early experiences of laparoscopic incisional hernia repair among Taiwanese patients. Thirty-seven patients with incisional hernia, twelve were recurrent, received laparoscopic underlay Dualmesh(superscript R) (ePTFE) repair at Cathay General Hospital in past two years with one conversion. The mean area of defect was 50.2 cm^2. Multiple defects were found in 13(35%) patients. Peri-operative complications included dysuria (2), seroma (2), ileus (1), trocar site bleeding (1) and wound infection (1). Post-operative hospitalizations ranged from 3 to 8 (mean; 4.3) days. Post-operative patients' questionnaire revealed less pain experienced during laparoscopic repair by those who had previous open repair. There were no recurrences during a 3 to 21 (mean; 9.1) months follow-up. Based on our initial results, laparoscopic incisional hernia repair is safe and feasible among Taiwanese. Comparing to the open repair, laparoscopic incisional hernia repair has less perioperative complications, debility, and short-term recurrence rate. Long-term recurrence is expected to be lower than conventional repair due to less surgical trauma and the tension-free nature of laparoscopic repair.

Objective To explore the feasibility, clinical application value and safety of laparoscopic surgery in treating patients with esophageal hiatal hernia. Methods The clinical data of 20 cases of esophageal hiatal hernia who were enrolled to undertake laparoscopic hiatal hernia repair and fundoplication at our hospital were retrospectively analyzed from March 2012 to September 2017, then we value their clinical results and prognosis. Results All 20 cases of laparoscopic operations were accomplished successfully and no conversions were needed, including 16 cases of Nissen operation, 4 cases of Toupet operation,20 cases of hernia repaired with non-absorbable suture, 7 cases repaired with U Soft Mesh.Mean operation time was 150 minutes (range: 95~180 minutes). Mean intraoperative blood lose was 40ml (range: 30~70 ml).Liquid diets were taken in after 24~48 hours of surgery. Clinical symptoms were effectively relieved in all cases and no mortality and severe complications were noted. Mean postoperative hospital stay were 4.1 days (range: 3~7days). 20 cases were all followed up, and mean follow up period was 2.6 years (range: 3 months to 5 years), there were no cases who dead and with anatomic recurrence, the rate of satisfaction for operation was 95.0%. Conclusion Minimally invasive laparoscopic surgery for esophageal hiatal hernia has the obviously advantages of minimal trauma, fast recovery, safe, high reliability and generalizable value. Key words: Esophageal hiatal hernia; Laparoscopy; herniorrhaphy; Fundoplication; Clinical analysis

Laparoscopic ventral incisional hernia repair: a more effective alternative to conventional repair of recurrent incisional hernia.

Objective To compare the application value between Hybrid technique and laparoscopic technique in irreducible inguinal hernia repair. Methods A total of 60 patients performed unilateral irreducible inguinal hernia repair in Langfang Fourth People's Hospital from January 2015 to December 2017 were included into this study. All patients were divided into two groups randomly, including Hybrid technique group (observation group, n=30) and laparoscopic technique group (control group, n=30). The operation time, pneumoperitoneum duration, blood loss, hospital stay, hospital cost, and postoperative complications were analyzed. Results In the control group, 1 patient was rejected out of the group because it was difficult to separate and reduce under laparoscopy. The rest of operations were performed successfully. No statistical difference was observed in hospital stay [(5.00±0.85) days vs (5.00±0.82) days], hospital cost [(10 901.8±830.22) yuan vs (11 116.45±813.73) yuan], postoperative fever (16.7% vs 20.7%), pain (26.7% vs 6.9%) between two groups (P>0.05). Operation time, pneumoperitoneum duration, intraoperative bleeding and incidence of seroma in the observation group were (57.00±5.81) minutes, (36.30±4.90) minutes, (21.00±3.80) ml, 1 case (3.3%), respectively, were significantly lower than those in the control group, (72.90±3.66) minutes, (65±4.43) minutes, (56.7±8.69) ml, and 7 cases (24.1%), (P<0.05). No recurrence, infection or chronic pain was observed at 1 year follow-up. Conclusion Compared with laparoscopy, Hybrid technique to treat irreducible inguinal hernia may decrease operation time, pneumoperitoneum duration, intraoperative bleeding and the incidence of seroma, and do not increase the risk of postoperative hernia recurrence and other complications and hospital cost. It is worthy to be used for clinical practice. Key words: Herniorrhaphy; Laparoscopes; Hybrid technique

Relevance The approaches to surgical treatment of patients with a combination of umbilical hernia and diastasis recti, remain controversial and need further investigation. The purpose of the study To improve the results in surgical treatment of patients with a combination of umbilical hernia and diastasis recti. Materials and methods We assessed the recurrence rate and development during a three year period after surgical treatment of 262 patients with combined umbilical hernia and diastasis recti. The patients were divided into 9 groups according to the size of the diastasis recti and the applied surgical procedure: a novel method of extraperitoneal prosthetic correction of the diastasis recti and umbilical hernia, autogenous umbilical hernioplasty without correction of the diastasis and simultaneous autogenous hernioplasty and correction of the diastasis using Championniere’s or Askerkhanov’s methods. Results and their discussion There were no cases of recurrence reported, when the novel method was used. After autogenous umbilical hernioplasty without correction of the diastasis relapses occurred in 9 (15,25%) and 29 (70,73%) patients with grade 1 and 2 diastasis, respectively. After simultaneous autogenous hernioplasty and correction of the diastasis a relapse occurred in 12 (30,77%) patients with a grade 2 diastasis and in 15 (93,75%) patient with a grade 3 diastasis. All cases of relapse occurred within the first year after the surgical treatment. Conclusion 1) In the presence of rectus diastasis isolated umbilical hernioplasty leads to a high recurrence rate (15,25% in patients with grade I diastasis and 70,73% in grade II), no matter how large the diastasis was. 2) Surgical procedures combining umbilical hernioplasty and autogenous correction of the diastasis are more effective (recurrence rate 30,77%) than isolated umbilical hernioplasty (recurrence rate 70,73%), but are considerably inferior to the method of extraperitoneal prosthetic correction of the diastasis recti and umbilical hernia (no recurrences at all). The effectiveness of autoplastic procedures considerably decreases with an increasing degree of diastasis (recurrence rate 30,77% in grade II diastasis, 93,75% in grade III diastasis). 3) Extraperitoneal prosthetic correction of the diastasis recti and umbilical hernia is considerably superior to both the isolated autogenous umbilical hernioplasty (recurrence rate 15,25% in patients with grade I diastasis and 70,73% in case of grade II diastasis) and the combined autogenous diastasis correcting methods (recurrence rate 30,77% in patients with grade II diastasis, 93,75% in case of grade III)

Objective To explore the effect of laparoscopic transabdominal preperitoneal hernia repair (TAPP) with 3D mesh on the pain degree and postoperative recurrence of inguinal hernia. Methods Seventy patients with inguinal hernia who underwent surgery in the First Affiliated hospital of Xinjiang Medical University from September 2016 to December 2017 were divided into the 3D mesh group (n=35) and the ordinary mesh group (n=35) according to the different meshes used during surgery. All patients were treated with TAPP. Among them, the mesh used in the 3D group was Bard-3DMAX hernia mesh, while the mesh used in the ordinary mesh group was Covidien (Tyco) hernia mesh. The operation indexes, postoperative pain visual analog scale (VAS), complications and recurrence of the two groups were observed and compared. Results There were no significant differences in operation time, hospital stay and intraoperative bleeding between the two groups (P>0.05). The operation-related expenses and the time of getting out of bed after operation in the 3D group were less than those in the ordinary mesh group (P 0.05). The score of VAS in the 3D group was lower than that in the ordinary mesh group at 24 hours, 72 hours, 7 days and 15 days after operation (P 0.05). Conclusion TAPP is a safe and effective surgical method. The use of 3D mesh can simplify the operation, reduce the postoperative pain of patients, and has reliable curative effect. It is worthy of clinical application. Key words: 3D mesh; Transabdominal preperitoneal prosthesis; Hernia, inguinal; Surgical indexes; Postoperative pain

Objective To compare the effect of traditional hernia repair and biological mesh hernia repair on young adults of childbearing age. Methods The clinical data of 62 cases of young adults of childbearing age admitted to the Nanjing Hospital of Nanjing Medical University from February 2014 to June 2015 were retrospectively analyzed. The patients were divided into two groups according to the operation method, including 30 cases of traditional hernia repair and 32 cases of biological mesh hernia repair. The length of hospital stay, cost of hospitalization, seroma, Incision dehiscence, degree of postoperative pain and pain in the surgical field after discharge were compared between the two groups. Results The operation of both groups was successfully completed. The cost of hospitalization and operation time in the traditional hernia repair group was lower than those in the biological mesh hernia repair group (t=-24.901, -5.342, P=0.000, 0.003). However, the number of postoperative pain and postoperative pain time in the traditional hernia repair group were significantly more than those in the biological mesh hernia repair group (χ2=9.854, 15.855, P=0.000, 0.003). There were no significant differences between the two groups in the length of stay and incision delayed healing (t=1.212, χ2=0.200, P=0.23, 0.655). All cases were followed up for 10 to 24 months with an average of 15.8 months. No complications such as hernia recurrence, patch infection or rejection, and testicular atrophy were observed in both groups. Conclusion For young adults of childbearing age, individualized treatment should be emphasized. According to Gilbert classification, type Ⅰ, Ⅱ are recommended to use the traditional hernia repair, and for type Ⅲ is recommended to use the biological mesh hernia repair. Key words: Hernia, inguinal; Young adults of childbearing age; Traditional hernia repair; Biological mesh

Objective To explore the clinical effect of laparoscopic transabdominalpreperitoneal (TAPP) and open preperitoneal hernia repair for inguinal hernia. Methods According to the different treatment options, 102 cases of inguinal hernia who treated in the first people's hospital of Jinzhong were randomly divided into the TAPP group (51) and the control group (51). The control group were given the open preperitoneal hernia repair. The operation time, amount of bleeding, and hospital stay were noted, and the incidences of postoperative recurrence, pain, hematoma, and infection between the two groups were compared. Results The hospital stay of the TAPP group was (4.65±0.78) days, obviously shorter than (6.08±2.23) days in the control group. The difference was statistically significant (P 0.05). Conclusion The clinical effect of TAPP repair is better than open preperitoneal hernia repair for inguinal hernia. Key words: Hernia, inguinal; Herniorrhaphy; Laparoscopy; Open preperitoneal hernia repair

Objective To explore the safety and therapeutic effect of 8 patients with esophageal Hiatal Hernia treated by laparoscopic hernia repair.Methods A retrospective analysis was performed on the clinical data of 8 patients with esophageal Hiatal Hernia form Jun.2009 to Jun. 2010.Among the participants,3 conducted 360-degree fundoplication,5 conducted partial(270-degree) fundoplication.Silk sutures were used for the repair of esophageal perforation in 4 patients,and patch repair was used for the other 4 cases.Results Eight patients were treated by laparoscopic hernia repair,and all of them were cured without postoperative complications.The mean duration of surgery was ( 120 ± 30) min,with average blood loss ( 50 ± 12 ) ml.Patients had a mean postoperative hospital stay of(4.5 ± 2.5 )days.All the patients were followed up for 1 to 2 years,and no case was found to be relapsed.Conclusion Total laparoscopic hernia repair is minimally invasive,with short recovery course,less pain after surgery,little complication and short hospitalized time.Laparoscopic Hernia repair should be the preferred effective operation method for patients with esophageal Hiatal Hernia. Key words: Laparoscopy; Esophageal Hiatal Hernia; Fundoplication