Mesh fixation with human fibrin glue (Tissucol) in open tension-free inguinal hernia repair: a preliminary report

Background: The Lichtenstein technique for inguinal hernia repair is easy to learn and associated with few complications. However, recent studies have suggested that this technique is inferior to some ‘sutureless’ repair systems in terms of perceived difficulty, operating time, surgeon satisfaction, etc. Methods: We employed a sutureless Lichtenstein technique in 80 consecutive patients with primary unilateral inguinal hernia, to assess patient and trainee surgeon outcomes. Human fibrin glue was used in place of conventional sutures. Results: The mean operating time was 36 min and all patients were discharged 5–6 h after the operation. On a 100-point visual analogue scale, the surgeons rated the difficulty of the operation as low (mean score, 31), and perceived satisfaction as high (mean score, 84). No complications were observed at 12-month follow-up. Conclusion: This study confirms the efficacy of mesh fixation with human fibrin glue, and supports the viability of a sutureless Lichtenstein procedure.     

Inguinal hernia repair in Hospital Authority hospitals: The role of laparoscopic hernioplasty

Objective: Two major changes have occurred in inguinal hernia repair during the last two decades: (i) the use of tension‐free mesh repair; and (ii) the application of laparoscopic technique for repair. The aims of the present study were to study: (i) how inguinal hernia repair was carried out; and (ii) the outcome of inguinal hernia repair in Hospital Authority (HA) hospitals. Methodology: This was a retrospective analysis on 8311 elective inguinal hernia repairs performed in 16 HA hospitals from January 2001 to December 2003. The mean age was 63.9 ± 14.2 years, and the male to female ratio was 22.0 : 1.0. Among these, 869 (10.5%) repairs were performed with the laparoscopic approach and 7442 (89.5%) repairs with the open approach. The proportion of laparoscopic hernia repair increased from 8.7% to 12.6%. Results: For open repair, 39% of cases were carried out with regional anaesthesia, 32% with general anaesthesia and 29% with local anaesthesia (LA). Furthermore, mesh repair was used in 88% of the patients. For laparosocpic repair, 98.4% of cases were carried out under general anaesthesia, and all patients had mesh repair using the totally extraperitoneal approach. A significantly higher proportion of bilateral repair and recurrent hernia repair was performed with the laparoscopic approach (P = 0.000). For primary unilateral repair, there was no significant difference in the postoperative length of stay (LOS) and the total LOS between the laparoscopic and the open surgery groups. No difference in LOS was found in recurrent hernia repair between the two groups. With respect to bilateral repair, both the preoperative LOS (P = 0.036) and total LOS (P = 0.039) were shorter in the laparoscopic group. Furthermore, a significantly higher proportion of day‐surgery patients was observed in the laparoscopic group than the open surgery group (21.3%vs 16.9%, P = 0.001). Nevertheless, when only the results of 2003 were analyzed, the postoperative LOS (P = 0.000) and total LOS (P = 0.000) were significantly shorter in the laparoscopic group than the open surgery group. The LOS parameters were significantly shorter in the open surgery LA subgroup compared with the non‐LA subgroup (P = 0.000), and they were not different from those in the laparoscopic group. Conclusions: The open mesh repair is the predominant approach for inguinal hernia repair in HA hospitals. The originally described local anaesthetic approach was under utilized, although it resulted in good outcome. The use of laparoscopic hernia repair is increasing and a learning curve was recently observed with improved outcome.     

改进后的腹腔镜腹腔内补片术在疝修补中的应用(附316例临床分析)

目的 腹腔镜腹腔内补片植入术(IPOM)，因有补片引起腹内组织粘连引发肠梗阻甚至复发等报道，目前争议较多，未能推广应用。作者改进了以上方法的多个步骤以克服该方法的不足。探讨改进后的方法在成人疝修补中的应用价值。方法 以缝合小儿疝的方法关闭内环口；把补片的中心固定在疝环口的中心：经腹壁用可吸收线代替钉合枪以针织的方法把补片四周牢牢地固定并展平紧贴在腹膜上。利用脐内侧韧带腹膜覆盖网片的内侧：减少网片外露的面积，减少粘连发生。结果 具有容易与腹膜相融合特性的网片能很快地与腹膜融合成一柔韧性组织，加强了疝环薄弱区，极少引起腹内肠管的粘连，更没有肠梗阻的发生，复发率低。结论 作者认为经过改进后的IPOM方法是一种效果确切、创伤少、并发症少、费用低、有微创优点。值得继续探索应用。     

无张力疝修补术治疗复发性腹股沟疝(附16例临床分析)

目的探讨无张力疝修补术在复发性腹股沟疝中的临床应用价值。方法自2002年1月至2005年1月,我院应用无张力疝修补术治疗复发性腹股沟疝16例进行回顾性分析。结果平均手术时间55min,术后1例出现阴囊积液,2例切口脂肪液化,无切口感染病例,平均住院5天,随访12～36个月均无复发。结论无张力疝修补术是治疗复发性腹股沟疝的较理想术式,具有安全、创伤小、术后恢复快、疗效满意,尤其是复发率低等优点。     

Parapubic hernia: case report and review of the literature

Parapubic hernia is considered rare, with 18 hernias described in five articles published since 1971. The hernia results from iatrogenically or traumatically detached rectus abdominis muscles at the pubic bone and presents a therapeutic challenge because there is no strong aponeurotic anchoring structure in the defect's caudal aspect. We describe a patient with a large parapubic hernia repaired by a combined preperitoneal and onlay prosthetic method. This report adds another dimension to the prosthetic repair options in parapubic hernias and illustrates the effectiveness of the tension-free repair principle in their definitive management. Electronic Publication     

老年疝环充填式无张力疝修补术的应用

目的：探讨老年人疝环充填式无张力疝修补术的近期疗效。方法：对35例次老年人疝环充填式无张力疝修补术的临床资料进行回顾性分析。结果：平均手术时间40min，住院天数3-7d。术后8-30h均能下床活动。全部未使用镇痛药物。并发症：急性尿潴留1例，恶心呕吐1例，术后低热2例。切口感染率及近期复发率均为0。结论：疝环充填式无张力疝修补术具有操作简便、创伤小、恢复快、无张力、低复发率、适应症宽的优点而成为老年腹股沟疝的理想术式。     

经阴道无张力吊带术治疗女性压力性尿失禁的体会

目的探讨经阴道无张力吊带术(TVT)治疗女性压力性尿失禁(SUI)的疗效及安全性。方法对2002年5月至2004年12月施行TVT的114例女性SUI患者资料进行回顾性研究。根据Stamey尿失禁分级系统评价TVT手术的有效性。术后较术前尿失禁等级评分改善2级或2级以上为显著改善,1级为改善,无改善甚至加重为无效。术后尿失禁等级为0~1级为完全控尿,2级为有效控尿,3~4级为无效。评估术前、术后的24h尿垫试验及尿动力学检查结果。并对并发症进行统计和分析。结果随访110例(96.5%),随访时间6~30个月。24h尿垫试验术前(38.3±10.4)g,术后(8.8±7.4)g;尿失禁症状评分从术前42.3±11.4,术后20.4±9.2;尿失禁等级评分显著改善者94例(85.5%),改善者12例(10.9%),无效者4例(3.6%)。术后完全控尿者89例(80.9%),有效控尿者14例(12.7%),无效者7例(6.4%)。术中发生膀胱穿孔2例(1.8%),出血14例(12.7%)。术后1个月内有排尿不畅者9例(8.2%),尿频、尿急者12例(10.9%),尿潴留者1例(0.9%);术后6个月后有耻骨上不适者8例(7.3%),排尿不尽者2例(1.8%),尿频、尿急者3例(2.7%)。1例反复尿潴留患者经保守治疗无效,最终将吊带切断。术后未出现吊带处阴道黏膜糜烂和明显盆腔血肿。结论TVT术是目前治疗女性SUI的一种有效、安全的微创手术。     

无张力性吊带术治疗女性压力性尿失禁

目的探讨无张力阴道吊带术(tension-free vaginal tape，TVT)治疗女性压力性尿失禁的疗效。方法13例经尿动力学检查证实为压力性尿失禁在连续硬膜外麻醉下经阴道前壁行无张力阴道吊带术，低平截石位，经阴道前壁向上穿刺尿道两侧间隙，从耻骨上腹壁引出TVT吊带，调整张力，关闭切口。结果手术时间15～45min，平均35min。13例随访6～24个月，平均13个月，12例治愈，1例改善，无尿失禁复发或排尿困难。结论TVT操作简单，创伤小，手术时间短，术后恢复快，治疗压力性尿失禁疗效好。