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1.
【摘要】〓目的〓比较腹腔镜腹股沟疝修补与开放性腹股沟疝修补的优缺点。方法 对2012年5月~2013年5月中山市中医院240例成人腹股沟疝修补术进行回顾性分析,其中开放性疝修补术(开腹疝修补组)148例,腹腔镜疝修补术(腔镜疝修补组)92例。收集两组患者的手术时间、住院时间、住院费用、术后复发、术后慢性疼痛、术后阴囊积液及术后感染的临床资料并进行比较。 结果 开腹疝修补组患者在平均手术时间、平均住院费用少于腔镜疝修补(P均<0.01);开腹疝修补组术后复发(3例)、术后慢性疼痛(11例)、术后阴囊积液(2例)及术后感染(1例)等总并发症高于腔镜疝修补组(P<0.05);两组的平均住院时间差异无统计学意义。结论 腔镜组腹股沟疝修补术具有较少的术后并发症,但在住院时间、住院费用方面没有优势。 相似文献
2.
Combined open and laparoscopic approach to chronic pain following open inguinal hernia repair 总被引:1,自引:0,他引:1
Introduction: Chronic groin pain is the most common long-term complication after open inguinal hernia repair. Traditional surgical management
of the associated neuralgia consists of injection therapy followed by groin exploration, mesh removal, and nerve transection.
The resultant hernia defect may be difficult to repair from an anterior approach. We evaluate the outcomes of a combined laparoscopic
and open approach for the treatment of chronic groin pain following open inguinal herniorrhaphy. Methods: All patients who underwent groin exploration for chronic neuralgia after a prior open inguinal hernia repair were prospectively
analyzed. Patient demographics, type of prior hernia repair, and prior nonoperative therapies were recorded. The operation
consisted of a standard three trocar laparoscopic transabdominal preperitoneal hernia repair, followed by groin exploration,
mesh removal, and nerve transection. Outcome measures included recurrent groin pain, numbness, hernia recurrence, and complications.
Results: Twelve patients (11 male and 1 female) with a mean age of 41 years (range 29–51) underwent combined laparoscopic and open
treatment for chronic groin pain. Ten patients complained of unilateral neuralgia, one patient had bilateral complaints, and
one patient complained of orchalgia. All patients failed at least two attempted percutaneous nerve blocks. Prior repairs included
Lichtenstein (n=9), McVay (n=1), plug and patch (n=1), and Shouldice (n=1). There were no intraoperative complications or wound infections. With a minimum of 6 weeks follow up, all patients were
significantly improved. One patient complained of intermittent minor discomfort that required no further therapy. Two patients
had persistent numbness in the ilioinguinal nerve distribution but remained satisfied with the procedure. Conclusions: A combined laparoscopic and open approach for postherniorrhaphy groin pain results in good to excellent patient satisfaction
with no perioperative morbidity. It may be the preferred technique for the definitive management of chronic neuralgia after
prior open hernia repair. 相似文献
3.
Background
In contrast to the well-described 10% risk of chronic pain affecting daily activities after adult groin hernia repair, chronic pain after childhood groin hernia repair has never been investigated. Studies of other childhood surgery before the age of 3 months suggest a risk of increased pain responsiveness later in life, but its potential relationship to chronic pain in adult life is unknown.Methods
This was a nationwide detailed questionnaire study of chronic groin pain in adults having surgery for a groin hernia repair before the age of 5 years (n = 1075).Results
The response rate was 63.3%. In the 651 patients available for analysis, pain from the operated groin was reported by 88 (13.5%) patients whereof 13 (2.0%) patients reported frequent and moderate or severe pain. Pain occurred primarily when exercising sports or other leisure activities. Patients operated on before the age of 3 months (n = 122) did not report groin pain more often or with higher intensity than other patients did.Conclusions
Groin pain in adult patients operated on for a groin hernia in childhood is uncommon and usually mild and occurs in relation to physical activity. Operation before the age of 3 months does not increase the risk of chronic pain. 相似文献4.
Burst strength of laparoscopic and open hernia repair 总被引:4,自引:0,他引:4
Background: There are few reports of overall strength of laparoscopic and open incisional hernia repair. Methods: After anesthesia, a 2-inch circular defect was made in the abdominal wall of 28 female swine. Gore-Tex DualMesh Biomaterial (W. L. Gore & Associates, Flagstaff, AZ) was used for all repairs. Sixteen animals underwent open repair and 12 underwent laparoscopic repair. Burst strength was detected within 2 weeks and at 6 weeks by euthanizing the animals and insufflating the abdominal cavity with water while measuring the intraabdominal pressure until it could no longer be pressurized. Results: Three events occurred after insufflation: rupture around patch (R), dissection from insufflation or pressure monitoring sites (D), or rectal prolapse (P). Failure after open early repair occurred at 289 (range 219–388) mmHg with 7-R, 1-P and late 289 (196–343) mmHg with 1-R, 6-P. Failure after laparoscopic early repair occurred at 259 (191–388) mmHg with 4-R, 1-P, 1-D and late 291 (140–330) mmHg with 2-R, 1-P, 3-D. Late groups were less likely to rupture. Conclusion: Both hernia repairs are durable at early and late periods. Tissue ingrowth adds to repair strength. We could not show that one repair was stronger than the other. Nonetheless, laparoscopic repair tended to degrade by dissection, which was our highest pressure event. 相似文献
5.
S. Delikoukos F. Fafoulakis G. Christodoulidis T. Theodoropoulos C. Hatzitheofilou 《Hernia》2008,12(6):593-595
Objectives Mild pain lasting for a few days is common following mesh inguinal hernia repair. In some patients however, severe groin pain
may appear months or even years postoperatively. The aim of this study was to report our experience of late-onset persisting
severe postoperative groin pain occurring years after mesh hernioplasty.
Methods In a 9-year period, 1,633 patients (1,073 men), median age 63 years (range 19–88), underwent mesh groin hernia repair. Between
1.5 and 4 years postoperatively, six patients (0.35%) presented with severe chronic groin pain unrelieved by conservative
measures and surgical exploration was essential. The patients’ records were retrospectively reviewed for the purpose of this
study.
Results Ilioinguinal nerve entrapment was detected in four patients. The meshes appeared to be indistinguishable from the nerve and
were removed along with the stuck nerve. New meshes were properly inserted. Mesh fixation on the periostium of the pubic tubercle
by a staple was found in the other two patients. The staples were removed from the periostium in both patients. Neither hernia
recurrence nor chronic groin pain was persisting in all six patients during a follow-up of 6–44 months postoperatively.
Conclusion From the results of this study, it appears that ilioinguinal nerve entrapment and/or mesh fixation on the periostium of the
pubic tubercle are the causes of late-onset severe chronic pain after inguinal mesh hernioplasty. Mesh removal, along with
the stuck ilioinguinal nerve and staple detachment from the periostium, are the gold-standard techniques if conservative measures
fail to reduce pain. 相似文献
6.
7.
Facilitation of open spigelian hernia repair by laparoscopic location of the hernial defect 总被引:1,自引:1,他引:0
A spigelian hernia is an uncommon entity. The diagnosis and location of this disorder often is difficult. We present a case in which the hernia could not be located at the time of operation, despite exploration. Laparoscopy performed subsequently enabled location and repair of the hernia under direct visualization, with good results. Laparoscopy is advocated as an adjunct to the diagnosis and treatment of spigelian hernia. 相似文献
8.
9.
目的探讨腹腔镜经腹腹膜前疝修补术(transabdominalpreperitoneal,TAPP)及开放式腹膜前间隙疝修补术的治疗效果。
方法回顾性分析2016年1月至2017年8月,山西医科大学附属晋中第一人民医院102例腹沟股疝患者的临床资料,根据治疗方法不同分为试验组与对照组,每组51例。对照组采用开放式腹膜前间隙修补术治疗,试验组采用TAPP术修补质量。对2组患者的手术时间、术中出血量、住院时间,以及术后复发、疼痛、血肿、感染等不良事件的发生情况进行比较。
结果试验组患者住院时间为(4.65±0.78)d,明显短于对照组的(6.08±2.23)d,差异有统计学意义(P<0.05)。术后随访4~18个月,试验组未见复发及术后血肿、感染,术后慢性疼痛2例、术后阴囊积液1例;对照组中复发3例、术后血肿5例、感染3例、慢性疼痛6例、术后阴囊积液7例;2组并发症发生率比较,差异有统计学意义(P<0.05)。2组患者在手术时间、术中出血量方面对比,差异均无统计学意义(P>0.05)。
结论TAPP对于腹股沟疝的治疗效果优于开放式腹膜前间隙疝修补术,具有显著临床优势。 相似文献
10.
Francisco Asencio Javier Aguiló Salvador Peiró Juan Carbó Ramón Ferri Federico Caro Marwan Ahmad 《Surgical endoscopy》2009,23(7):1441-1448
Background Incisional hernia is a common complication following abdominal surgery. Although the use of prosthetics has decreased recurrence
rates, the standard open approach is still unsatisfactory. Laparoscopic techniques are an attempt to provide similar outcomes
with the advantages of minimally invasive surgery.
Methods Open randomized controlled clinical trial with follow-up at 1, 2, 3, 7, and 15 days, and 1, 3, and 12 months from hernia repair.
The study was carried out in the surgery departments of three general hospitals of the Valencia Health Agency.
Objectives To compare laparoscopic with anterior open repair using health-related quality of life outcomes as main endpoints.
Results Eighty-four patients with incisional hernia were randomly allocated to an open group (OG) (n = 39) or to a laparoscopic group (LG) (n = 45). Seventy-four patients completed 1-year follow up. Mean length of stay and time to oral intake were similar between
groups. Operative time was 32 min longer in the LG (p < 0.001). Conversion rate was 11%. The local complication rate was superior in the LG (33.3% versus 5.2%) (p < 0.001). Recurrence rate at 1 year (7.9% versus 9.7%) was similar in the two groups. There were no significant differences
in the pain scores or the EQ5D tariffs between the two groups during follow-up.
Conclusions Laparoscopic incisional hernia repair does not seem to be a better procedure than the open anterior technique in terms of
operative time, hospitalization, complications, pain or quality of life. 相似文献
11.
In Geol Ho Kyong Ihn Eun-Jung Koo Eun Young Chang Jung-Tak Oh 《Journal of pediatric surgery》2018,53(10):2008-2012
Purpose
This study aimed to evaluate the usefulness of laparoscopic repair of inguinal hernia (LR) in infants in comparison with open hernia repair (OR).Methods
We retrospectively analyzed the clinical data of 465 infants treated for inguinal hernia from January 2006 to December 2015. Among them, 124 underwent LR and 341 underwent OR.Results
In the OR group, 16.1% (55/341) primarily underwent bilateral inguinal hernia repair and 13.6% (42/308) subsequently developed metachronous contralateral inguinal hernia during follow-up. In the LR group, 75.8% (94/124) underwent primary bilateral inguinal hernia repair and only 1.6% (2/123) developed metachronous contralateral inguinal hernia. The mean operation times of unilateral inguinal hernia repair showed no statistical differences between LR and OR. However, the mean operation times of bilateral inguinal hernia repair were shorter in LR (39.8 ± 10.4 vs. 51.1 ± 14.4 min, p < 0.001). Postoperative recurrence and wound infection showed no statistical differences between the groups, but postoperative scrotal swelling was more common in OR (0.0% vs. 4.0%, p = 0.006).Conclusion
LR in infants showed a lower incidence of metachronous hernia, shorter operation times, and better postoperative course than OR. LR could be considered the primary operation method in infants with inguinal hernia.Levels of Evidence
Prognosis Study, Retrospective Study, Level III. 相似文献12.
BACKGROUND: Spigelian hernias are rare defects of the abdominal wall usually appearing between the abdominal muscles, lateral to the rectus abdominis and through a debilitated Spigelian aponeurosis. Recently, mesh repair has been introduced for the treatment of these types of hernias and different approaches have been proposed. METHODS: Nine patients with Spigelian hernia were prospectively treated by placing a mesh prosthesis between the external oblique and the internal oblique muscles, based on principles of mesh repair established by the Lichtenstein group. RESULTS: Five women and 4 men, mean age 75.7 years, were operated on. In 1 patient the Spigelian hernia was an incidental finding during an inguinal hernia repair. Two patients were operated on an emergency basis. Elective operations were undertaken in ambulatory facilities in 3. Two patients had postoperative ecchymosis with no associated morbidity. No recurrences have been observed during follow-up. CONCLUSIONS: Open mesh repair of Spigelian hernias placing the mesh between the external and internal oblique muscles is a simple and safe approach that can prevent morbidity related to other techniques. 相似文献
13.
Plug repair of groin hernias: a 10-year experience 总被引:1,自引:0,他引:1
Gabriel Dieudonné 《Hernia》2001,5(4):189-191
From April 1990 to July 2000 we performed 4,024 hernia operations and implanted 3,332 plugs in groin hernias. This technique
was performed on a continuous, progressive basis. Between 1990 and 1994, the percentage of plugs was 67%, with the proportion
rising to 92% since 1995. Although we initially used them only for indirect inguinal hernias (1990–1994), in 1995 we began
inserting plugs in direct defects [Marlex Perfix Plug, (Bard Company, 78196 Trappes, France) January 1995–July 1997]. On the
basis of our own cases of recurrence, we reoperated and modified plugs using a new prosthesis (Obtura Mesh, Cousin Company,
Wervicq Sud 559558, France). Maximum follow-up was 10 years, with 84% of the patients followed for more than 1 year. Postoperative
mortality was zero, local infection occurred in 20 patients (0.6%) and testicular atrophy was observed with 27 patients (0.8%).
The recurrence rate was 1.4%.
Electronic Publication 相似文献
14.
Early results from the use of the Lichtenstein repair in the management of strangulated groin hernia
Background Use of prosthetic repairs in the management of strangulated hernias has so far been very limited due to the fear of an associated
higher incidence of complications, especially those related to the presence of the mesh. The aim of this study was to prospectively
determine whether the use of the Lichtenstein repair in the management of strangulated groin hernias was associated with a
higher rate of wound infection and/or mesh-related complications than in the elective setting.
Patients and methods The results obtained from the use of the Lichtenstein repair in the management of 25 patients with strangulated groin hernias
(group I) were compared to those of another 25 age- and sex-matched patients undergoing Lichtenstein repair for elective groin
hernia repair (group II).
Results In group I, one patient (4%) developed a scrotal hematoma. No other postoperative complications were encountered, whether
related or unrelated to the presence of the mesh. No complications were encountered in group II patients. Throughout the 20-month
duration of the present study, no mesh had to be removed and no recurrences were encountered in either group.
Conclusion The good short-term results of the present study in terms of absence of wound infection, mesh-related complications and recurrence
suggest that use of the Lichtenstein repair in the management of strangulated groin hernias is safe and is not associated
with a higher rate of complications compared to its use in the elective setting. 相似文献
15.
Promising new technique in the repair of parastomal hernia 总被引:6,自引:3,他引:3
Parastomal hernia is a common complication after stoma formation. Although not all hernias require surgical repair, a variety of surgical techniques exist. Facial repair, relocation of the stoma, and the local use of a nonabsorbable mesh are the three major approaches. Despite this variety of techniques, recurrence rate and complications are high. We therefore invented a laparoscopic technique where we close the hernia and reinforce it with a hand-made funnel-shaped Gore-Tex dual mesh. This technique has all advantages of laparoscopy (less pain, short hospitalization) combined with the advantages of local mesh repair (no stoma replacement necessary, low recurrence rate). The risk of infection is also minimized. The shape of the Gore-Tex mesh reduces hernia recurrence even more, prevents prolaps, and allows easy colonoscopy and stoma irrigation. 相似文献
16.
Almost 40 years of lucky existence is enough time for questioning and/or updating the Stoppa method for hernia repair. In
this paper, the author reports the circumstances of the birth of this method more than 30 years ago, recalls its innovative
principles, describes its technical aspects, and exposes its good results. Not simply approving old concepts, the author concludes
with critical remarks with regard to a so-called political correctness of today's groin hernia repair, which gives great importance
to reducing patient trauma arising from surgery. For belief without doubt can be wrong belief!
Electronic Publication 相似文献
17.
Background: During laparoscpic transabdominal preperitoneal (TAPP) repair of unilateral groin hernias, a significant proportion
of patients are found to have unsuspected hernias (incidental defects) on the contralateral side without any clinically demonstrable
signs. The reported incidence is 10% to 25%, and controversy exists about the routine repair of these hernias. We present
the early results of a prospective randomized study designed to follow the clinical behavior of incidental defects. Methods:
For this study, 32 consecutive men found to have incidental defects on the contralateral side during laparoscopic TAPP repair
of groin hernias were prospectively randomized into two categories. In 16 patients (control group), the defects were repaired
simultaneously, and in another 16 patients (trial group), surgical repair was not performed. Subsequently, five consecutive
patients found to have incidental defects were included in the trial group. Hence, the total number of patients with unrepaired
defects was 21. All the patients subsequently were followed up in the clinic and examined by an independent clinician to detect
any clinically demonstrable hernias. Results: The median follow-up was 15 months for the control patients and 12 months for
the trial patients. During this time, demonstrable hernias developed in 6 patients of the trial group (28.6%). Conclusions:
This study demonstrated that despite a short follow-up period, a significant proportion of incidental defects will progress
to a symptomatic hernia if left untreated. Hence, their simultaneous repair is justifiable on the grounds that it reduces
the number of operations and hospital visits, and thus the cost to the National Health Service. It also is of major benefit
to the patient. 相似文献
18.
Laparoscopic versus open ventral hernia mesh repair: a prospective study 总被引:15,自引:4,他引:11
Background An incisional hernia develops in 3% to 13% of laparotomy incisions, with primary suture repair of ventral hernias yielding
unsatisfactory results. The introduction of a prosthetic mesh to ensure abdominal wall strength without tension has decreased
the recurrence rate, but open repair requires significant soft tissue dissection in tissues that are already of poor quality
as well as flap creation, increasing complication rates and affecting the recurrence rate. A minimally invasive approach was
applied to the repair pf ventral hernias, with the expectation of earlier recovery, fewer postoperative complications, and
decreased recurrence rates. This prospective study was performed to objectively analyze and compare the outcomes after open
and laparoscopic ventral hernia repair.
Methods The outcomes for 50 unselected patients who underwent laparoscopic ventral hernia repair were compared with those for 50 consecutive
unselected patients who underwent open repair. The open surgical operations were performed by the Rives and Stoppa technique
using prosthetic mesh, whereas the laparoscopic repairs were performed using the intraperitoneal onlay mesh (IPOM) repair
technique in all cases.
Results The study group consisted of 100 patients (82 women and 18 men) with a mean age of 55.25 years (range, 30–83 years). The patients
in the two groups were comparable at baseline in terms of sex, presenting complaints, and comorbid conditions. The patients
in laparoscopic group had larger defects (93.96 vs 55.88 cm2; p = 0.0023). The mean follow-up time was 20.8 months (95% confidence interval [CI], 18.5640–23.0227 months). The mean surgery
durations were 90.6 min for the laparoscopic repair and 93.3 min for the open repair (p = 0.769, nonsignificant difference). The mean postoperative stay was shorter for the laparoscopic group than for the open
hernia group (2.7 vs 4.7 days; p = 0.044). The pain scores were similar in the two groups at 24 and 48 h, but significantly less at 72 h in the laparoscopic
group (mean visual analog scale score, 2.9412 vs 4.1702; p = 0.001). There were fewer complications (24%) and recurrences (2%) among the patients who underwent laparoscopic repair
than among those who had open repair (30% and 10%, respectively).
Conclusions The findings demonstrate that laparoscopic ventral hernia repair in our experience was safe and resulted in shorter operative
time, fewer complications, shorter hospital stays, and less recurrence. Hence, it should be considered as the procedure of
choice for ventral hernia repair. 相似文献
19.
Background In this randomized and prospective study, we compared the analgesic effects of lornoxicam and tramadol in patients after inguinal
hernia repair.
Methods A total of 160 patients were assigned in a randomized manner into two groups. Group L received 8 mg lornoxicam i.v. at the
end of the operation, followed by 8 mg 12 h after the operation. Group T received 1 mg/kg tramadol at the end of the operation
and every 6 h up to 24 h postoperatively. The visual analog scale (VAS) score was assessed at 0, 2, 4, 8, 12, and 24 h after
surgery.
Results All patients completed the study. All vital signs were within normal ranges. The mean VAS score in Group L and in Group T
was 21.66 ± 14.64 and 19.75 ± 11.82, respectively. No significant differences were found between groups with respect to VAS
score. Eight (10%) patients in Group T had nausea.
Conclusion Lornoxicam 8 mg i.v. and b.i.d., tramadol 1 mg/kg at the end of the surgery and every 6 h up to 24 h after inguinal hernia
repair provided rapid and effective analgesia and was well tolerated. 相似文献
20.