50例股疝疗效分析

目的评估股疝术后患者发病率和死亡率的影响因素。方法对2005年6月到2008年6月50例股疝修补术后患者进行回顾性分析。手术方法为McVay疝修补术和Lichtenstein无张力疝修补术。研究性别,年龄,修补技术,嵌顿／绞窄的情况,嵌顿／绞窄的器官,术后并发症,住院时间,复发率,影响发病率和死亡率的因素。结果50例股疝患者中,年龄范围23岁至77岁（平均年龄48．74岁）,其中女性患者占72％。20例（40％）患者因嵌顿／绞窄行急诊手术,其中16例疝内容物为大网膜,4例发生小肠绞窄行肠切除。30例（60％）患者行择期手术。所有患者中44例行Lichtenstein无张力疝修补术,6例行McVay疝修补术,1例急诊手术术后伤口感染,无死亡病例,无复发病例。结论股疝容易发生嵌顿／绞窄,对老年患者而言,急诊手术增加手术风险和死亡率,因此股疝患者应尽早手术治疗。     

Recurrent hernias after previous Shouldice operation

For all 158 surgical operations performed on hernia recurrences throughout the period from March 2000 until the end of May 2001, we compared the intra-operative findings to the information contained in the operation reports--as far as available--as part of our quality management. In less than 20 % of the patients for whom a Shouldice repair had been documented in the operation reports, we found evidence of the actual performance of a Shouldice repair (typical cicatrised modifications on the rear wall or the fascia transversalis, sutures or residues of sutures). 74 % of the patients were treated with a Marlex(R) Perfix plug, avoiding the resection of stable cicatrisation fractions with incision of the rear wall in the case of an intact fascia. On 26 % of the patients it was possible to perform a Shouldice repair in compliance with the original technique. Meanwhile, mesh techniques have outpaced the Shouldice technique with respect to the recurrence rates in the efficiency statistics. This, however, is not caused by the technique as such, but rather by the fact that in many clinics the anatomical situations are obviously incorrectly assessed and/or that insufficient knowledge about suturing techniques prevails. As a consequence, worse results are reported for the Shouldice technique than for the mesh techniques. It is not the Shouldice technique that is insufficient but its performance suffers in many hospitals from substantial insufficiencies in terms of quality.     

Recurrent inguinal hernias in infants and children

The objective of this study was to analyze the etiologic factors possibly associated with the development of recurrent groin hernias in infants and children. For this purpose we analyzed the records of 2754 pediatric patients operated on for primary hernias between 1966 and 1990 at our department who have not had recurrences. They were compared with 28 boys and 4 girls we treated for recurrent hernias during the same period. We found an indirect hernia in 29 cases, a direct hernia in 4 patients, and a femoral hernia in 1 child at the time of reoperation. A significantly high recurrence rate was found to be associated with incarceration (21.9% versus 7.6%) postoperative complications (9.4% versus 1.8%), concomitant diseases (31.2% versus 5.7%), and premature birth. Day case treatment was closely related to concomitant diseases. No impact on the development of recurrences was seen for the surgeons' educational level and the time of day the surgery was performed. Knowledge of the factors contributing to hernia recurrence and perfect surgical technique with reduction of incarcerated hernias and early elective operation may result in fewer recurrences in infants and children.     

Clinical study of inguinal and femoral incarcerated hernias

Purpose  

Inguinal and femoral hernias are common disorders associated with aging. Incarcerated external hernias, however, are often fatal. This study investigated the prognostic factors in patients with incarcerated hernias.     

Complications of endovideosurgical repair of inguinal and femoral hernias

On the basis of an experience with 1800 operations of endovideosurgical hernioplasty in patients with inguinal and femoral hernias, the authors analyze the frequency and character of complications after such operations. Complications were noted in 37 (2.05%) patients. The most frequent complication was injury of the vessels. It could be liquidated in all the cases using laparoscopic technology. In three cases hollow organs were injured. In these cases laparotomy was used. The laparoscopic hernioplasty, if all details are fulfilled thoroughly, is a minimally invasive and effective method of treatment of inguinal and femoral hernias. The frequency of recurrences after these interventions is considerably less than that after traditional operations.     

Repair of femoral hernias with “plug” technique

Summary Femoral hernia is one of the less frequently encountered forms of groin hernia, but nonetheless produces a considerable amount of surgical concern. The repair of femoral hernia utilizing traditional sutured techniques is frequently associated with complications and a significant incidence of recurrence. A series of 24 cases repaired with the meshplug technique is presented with technical details of the operative procedure. All of these operations were performed on an ambulatory basis in an out-of-hospital, government-certified, ambulatory surgical environment. Not a single case of recurrence or other significant complication has been encountered. This retrospective study demonstrates the efficacy and reliability of plug repair of femoral hernia.     

Synchronous femoral hernias diagnosed during endoscopic inguinal hernia repair

Background  

During totally extraperitoneal (TEP) endoscopic repair of inguinal hernias, it is possible to see the internal opening of the femoral canal. The aim of our study was to determine the incidence of synchronous femoral hernias found in patients undergoing TEP endoscopic inguinal hernia repair.     

Recurrent inguinal hernias: surgery with transversalis fascia repair]

Some authors recommend different prosthetic repairs for treatment of recurrent groin hernia. In our institution groin hernias are treated by a modified Shouldice-repair, which considers the transversalis fascia layer only. In this prospective study 240 consecutive patients with 298 groin hernias were operated on. 46 patients were treated for 53 recurrent hernias. It was possible to carry out the operative procedure of transversalis plasty in all recurrent cases. 90% of these patients were followed-up by personal examination after a median of 26 months after operation (range 12-36 months). 89% of the patients with primary operation have been checked 15 months postoperatively. 2 patients (4.5%) of the recurrent hernias had a recurrence. This compares well with the 3.2% recurrence rate (7 patients) in the patients with primary hernias. The difference is not significant (p greater than 0.5). The only observed difference between recurrent and primary hernias was in the rate of testicular atrophy (6.8% for recurrent and 0% for primary hernias). According to our experience large prosthetic repairs are not necessary for the common case of recurrent groin hernia, but may be useful in specially selected situations.     

The Henry operation for incarcerated and strangulated femoral hernias.

Selection of a subinguinal, inguinal, or preperitoneal approach permits the surgeon flexibility in managing femoral hernias. A 20-year experience is reviewed, with 44 incarcerated or strangulated femoral hernias corrected using the preperitoneal Henry operation. It is an effective and safe method of repair. Examination of the contralateral side revealed an unsuspected femoral hernia in seven (16%) of the cases.     

Inguinal and femoral hernias. Long-term results in a community hospital

During the period 1967-1976, 938 repairs of inguinal or femoral hernia were performed in adults or children. The patients were followed up for at least five years. Primary inguinal hernia was treated in 558 men. The right:left ratio was 59:41%. The recurrence rate was 8.4%, with slight left-sided predominance. The frequency of recurrence was higher for direct than for indirect hernia. The recurrence rate was dependent more on the surgeon than on the type of operation, though experienced surgeons and surgeons in training achieved similar figures. Femoral hernia showed increased frequency in men previously operated on for inguinal hernia. The series included 118 hernia repairs in children, using inguinal or suprapubic approach. The question of bilateral exploration is discussed. The recurrence rate in boys was 3.8% and postoperative testicular affection was found in 7.5%.     

Aetiology of femoral hernias revisited: bilateral femoral hernia in a young male (two cases)

Bilateral femoral hernias are less common in men than in women and rare in young adults. Only one case of a bilateral femoral hernia in a young man has been reported in the literature before. Three main theories have been postulated for femoral hernias. The theory that they are an acquired disease is the most accepted due to the common occurrence of such hernias in multiparous women but the theory lacks enough evidence. We report two cases in young men. Anatomical variations in the femoral canal could be the primary aetiological factor in these patients. A unilateral femoral hernia in young men with acquired aetiological factors requires a clinical examination of the opposite side.