Day surgery for pediatric inguinal hernia repair

Pediatric patients with inguinal hernia can be good candidates for day surgery. Since 1986, 1273 such patients have been treated under our day surgery system. Although 8 patients (0.6%) were unable to go home after surgery due to perioperative complications and 21 (1.6%) visited earlier than scheduled after discharge, no major complications were noted and postoperative complications did not differ from those seen in the inpatient setting. Our questionnaire survey demonstrated that 96% of the families were satisfied with the system. Based on our own experience and a literature review of day surgery for inguinal hernia repair in children, the problems surrounding the day care system are discussed. Patient selection, preoperative assessment, general anesthesia, postoperative care including oral intake and analgesia, and postoperative follow-up are considered the most important issues in the day care system. A team approach including pediatric surgeons, anesthesiologists, and pediatric nurses is considered indispensable for the safe and satisfactory day surgery treatment.     

Day care surgery of inguinal hernia and hydrocele of children

From March 1983 to December 1989, day care operations were done for 12099 children (inguinal hernia 10913, hydrocele 1186) aging from 6 months to 13 years (75.9% of the children were under three). The postoperative complication rate was 0.84% and 15 children (0.12%) required hospitalization. The procedures and indications of the two operations and measures to prevent postoperative complications are discussed. We consider that day care surgery is safe and effective in minimizing the psychological burden of hospitalization, reducing hospital costs and decreasing the risk of cross-infection.     

成人腹股沟疝外科治疗的个体化方案选择

目前治疗成人腹股沟疝的外科手段为有开放式疝修补术和腹腔镜疝修补术。虽然治疗方法很多,总体效果良好,但每一种方法均有其弊端,外科医生常根据患者的性别、伴随疾病、既往病史、文化、收入水平等情况来选择手术。如何选择适当的手术方式有助于降低并发症率和减轻患者经济负担。本文就成人腹股沟疝个体化外科治疗进行综述。     

腹腔镜与开放腹膜前疝修补手术治疗成人腹股沟疝的成本效益分析

目的从成本-效益角度对比分析腹腔镜与开放腹膜前疝修补手术在成人腹股沟疝中的应用情况。 方法纳入2019年1-12月在眉山市人民医院诊治的单侧腹股沟疝患者132例，患者自主选择手术方式，开放手术组52例，腹腔镜手术组80例。成本费用计算包括住院费用、手术费用、其他费用；使用《欧洲五维健康量表（EQ-5D）中文版》在术后1 d、7 d、15 d分别对患者进行获益评价，并据此计算质量调整生命年（QALYs），进而计算和分析成本效益比（C/E）及增量成本效益比（ICER）。 结果开放手术组的平均总费用为7742.72元，腹腔镜手术组的平均总费用为12 866.56元。开放手术组和腹腔镜组的QALYs在第1天分别为0.501±0.178/0.692±0.106，第7天为0.673±0.123/0.814±0.042，差异均有统计学意义；第15天时QALYs分别为0.809±0.046/ 0.821±0.040，差异无统计学意义。腹腔镜组在第1天的ICER为3138.76（元/QALYs）；第7天时的ICER为4301.8（元/QALYs）；敏感性分析得出腹腔镜组在第1天和第7天C/E变化影响最大的费用是材料费；临界值分析显示如果材料费下降到5082.32元或3752.68元时腹腔镜组和开放组分别在第1天和第7天的C/E相当。 结论腹腔镜腹股沟疝手术后第1天和第7天时患者生活质量要高于开放手术患者，在第15天时二者没有差异。腹腔镜手术治疗腹股沟疝虽然费用较高，但是对于提高生活质量来说是相对值得的。     

成人复发性腹股沟疝个体化治疗体会

目的总结成人复发性腹股沟疝个体化治疗经验,探讨最佳治疗模式。方法回顾性分析2005年2月至2010年7月我院收治的49例(53例次)复发性腹股沟疝的临床资料。其中开放式无张力修补术30例(32例次),腹腔镜下腹股沟疝修补术(LIHR)19例(21例次)。观察手术时间、留院时间、术后并发症及随访情况。结果所有患者手术均成功,手术时间(42±15)min,术后平均住院时间为(3.8±1.1)d,围手术期无死亡患者,术后尿潴留5例,阴囊血清肿4例,无感染患者。术后均获得随访,随访时间24～89个月,复发2例患者。结论复发性腹股沟疝的治疗中应用人工合成材料进行无张力修补是根本原则,合理选择手术方式,采取个体化治疗模式,可取得最佳治疗效果。     

Outcome of inguinal hernia surgery

A consecutive series of 584 patients, operated for 635 groin hernias, was clinically evaluated at a median of 6 years after surgery. The cumulative recurrence rate was 16%, established by clinical examination and in uncertain cases with herniography; for primary hernias 14.6% and for recurrent hernias 20.7%. The recurrence rate for indirect hernias was 12.9% and for direct hernias 25%. The direct type of hernia was more frequent among recurrent hernias than among primary hernias (p less than 0.005), indicating that they were overlooked at or caused by the primary operation. The recurrences were noted by the patients themselves in 71% but only 58% had taken the initiative towards another repair. Considering the great number of hernia operations performed and the presented poor long-term results, the need for more research and interest focused on hernia surgery is indicated.     

'Incidentaloma' in inguinal hernia surgery

Adult Granulosa-Cell Tumor (GCT) is an uncommon ovarian malignancy. The clinical course is characterized by slow growth with late recurrence. A variety of clinical and pathologic parameters have previously been evaluated for prognosis with inconclusive results. The aim of this study was to report a case of a granulosa-cell tumor of the ovary that recurred 25 years after first surgery. The clinical course and histopathology of the case were reviewed and a literature search for other reported cases was performed.     

成人腹股沟疝、股疝手术治疗方案

[腹股沟疝] 腹股沟疝的形成受多种因素影响,除先天性因素外,常与腹内压增高有关。除嵌顿疝外,以常见发病部位的可复性肿物为诊断依据。成人疝是不可自愈的,手术是唯一有效的治疗方法。 100多年来,腹股沟疝修补术经历了漫长的历史,出现了Bassini手术,McVay,Halsted和Shouldice手术等。近20年来,无张力修补手术在发达国家已经成为治疗腹股沟疝的主要手术。为此,我们对腹股沟疝、股疝的手术治疗提出下列建     

改良李金斯坦无张力疝修补术应用于腹股沟疝的临床治疗

目的 探讨改良李金斯坦（Lichtenstein）疝修补术用于成人腹股沟疝的临床效果.方法 回顾性分析广州医科大学附属第五医院2010年3月至2013年4月收治的130例改良Lichtenstein无张力疝修补术患者的临床资料.结果 全组患者均获治愈,手术时间35～110 min,平均（43±13） min,住院时间2～15 d,平均（4.5±2.4）d,围手术期无严重并发症发生.随访3～36个月,平均（25±9）个月,无一例复发.结论 改良Lichtenstein疝修补术具有安全、可靠、操作简单的特点,符合现代疝修补的耻骨肌孔理念     

3D腹腔镜与开放手术治疗成人双侧腹股沟疝的对比研究

目的:探讨3D腹腔镜手术治疗成人双侧腹股沟疝的疗效。方法:回顾分析2012年5月至2016年5月为45例双侧腹股沟疝患者行3D腹腔镜经腹腹膜前疝修补术的临床资料,与同时期行常规开放无张力疝修补术的39例患者进行对比分析。结果:腹腔镜组手术时间、术中出血量、术后住院时间、止痛剂使用例数、切口感染率、尿潴留率优于开放组(P0.05),阴囊水肿、复发率两组差异无统计学意义(P0.05)。结论:3D腹腔镜经腹腹膜前疝修补术具有手术时间短、术后康复快、术后并发症少等优势,治疗成人双侧腹股沟疝是安全、有效、可行的。     

临床路径管理模式下成人腹股沟疝日间手术应用研究

目的探讨成人腹股沟疝日间手术临床路径的实施及应用效果。 方法收集2014年1月至2016年6月聊城市人民医院收治的120例成人单侧腹股沟疝患者的临床资料,按照患者意愿分为临床路径组（观察组）56例和住院手术组（对照组）64例,分析两组患者住院时间、住院费用、手术效果及术后并发症等情况,并进一步做成本-效果分析。 结果两组患者的手术时间、术中出血量、术后并发症发生率等指标比较,差异无统计学意义（t=0.397、0.790,P=0.823、0.430;χ²=0.250,P=0.617）;观察组患者的住院时间及住院总费用均显著低于对照组（t=10.851、6.755,均P<0.001）。成本-效果分析显示观察组患者每减少1例术后并发症,需要消耗的社会成本均低于对照组。 结论应用临床路径管理模式能够显著降低成人腹股沟疝患者住院医疗成本,在提高效率的同时最大程度地降低医疗风险,保障日间手术的安全,提高医疗质量。     

Locoregional anesthesia in inguinal hernia surgery

BACKGROUND: It is a current opinion that local anesthesia (LA) is the primary choice in surgical treatment of the inguinal region, particularly herniorrhaphy. The LA technique personally used for herniorrhaphy is described: it consists of iliohypogastric, ilioinguinal and genito-femoral nerve blocks, and incision line anesthetic infiltration. METHODS: From January 1998 to April 1999, 95 patients underwent inguinal herniorrhaphy employing LA: 77 (81%) in elective surgery, 18 (19%) in emergency; 2 cases with bilateral hernia (97 total LA procedures). RESULTS: Partial success was obtained in only 8 cases (8.4%), which required an association with a hypnotic drug ("blended anesthesia": propofol or midazolam): there were no cases of conversion to general anesthesia. Specific complications of local anesthetic drugs infiltration developed in 8 cases on 97 LA procedures (8.2%), but none required reoperation: 6 inguinal hematomas, 1 female external genitalia hematoma, 1 hematocele. CONCLUSIONS: In conclusion, it is stressed that LA is the technique of choice in herniorrhaphy and surgery of other inguinal pathologies, associating high success rates, rare complications and rapid dismissal: this allows for easy management of the patients and a very important reduction of sanitary costs. The association of LA-hypnotic drugs (blended anesthesia) represents another important resource, since it avoids general anesthesia in many cases and allows a rapid psychophysical recovery.     

快速康复外科理念在成人腹股沟疝日间手术的应用体会

目的探讨快速康复外科理念指导下的成人腹股沟疝日间手术的安全性及有效性。 方法采用前瞻性研究方法,将符合入选条件的67例患者分为试验组与对照组。试验组采用快速康复外科理念指导下的日间手术治疗成人腹股沟疝,麻醉方式为局部浸润麻醉;对照组为住院手术患者,常规采用椎管内麻醉。分析比较2组术后2 h疼痛评分、术后下床活动时间及术后进食或饮水时间、术后并发症发生情况及平均住院费用;记录试验组15 d内非计划再次入院率、日间手术延迟出院率。 结果试验组术后2 h疼痛评分（3.6±1.1）分、术后下床活动时间（3.2±1.1）h、术后进食或饮水时间（2.3±0.9）h及平均住院费用（4060.0±91.3）元与对照组（6.0±1.0）分、（7.2±1.1）h、（7.1±0.9）h、（5635.6±229.0）元比较,差异均有统计学意义（P<0.05）。2组术后并发症发生情况差异无统计学意义（P>0.05）,术后随访4~16个月,均无复发。试验组无15 d内非计划再次入院及日间手术延迟出院患者。 结论快速康复外科理念指导下的成人腹股沟疝日间手术,安全有效。     

成人腹股沟疝腹腔镜修补术512例

目的 总结成人腹股沟疝腹腔镜修补术的经验,分析常见的手术并发症和术后复发原因.方法 回顾性分析2007年3月至2010年9月行腹腔镜腹股沟疝修补术512例患者的临床资料,单侧腹股沟疝437例(斜疝281例、直疝86例、股疝15例、复合疝16例,复发疝39例),双侧腹股沟疝75例(含复发疝3例),其中包括急性腹股沟嵌顿疝41例.术后平均随访时间(29±12)个月.结果 512例中,507例患者成功行腹腔镜修补,完成经腹腹膜前补片植入术( transabdominalpreperitoneal,TAPP)238例(292侧),完全腹膜外补片植入术(totally extraperitoneal,TEP) 269例(290侧);5例中转开放手术.平均手术时间TAPP(69±19)min、TEP (58±15) min;术后平均住院时间(5.0±1.5)d;术后2周和4周恢复非限制活动人数分别为95.7％( 485/507)、99.0％(502/507);术后并发症依次为血清肿9.7％ (49/507)、暂时性神经感觉异常4.1％ (21/507)、术后慢性疼痛0.8％(4/507).术后复发率0.6％ (3/507).结论 腹腔镜腹股沟疝修补术具有创伤小,恢复快,复发率低等优点.     

Local anesthesia plus deep sedation for adult inguinal hernia repair in an ambulatory surgery center

Summary Two hundred consecutive adult patients receiving Perfix mesh plugs and onlay mesh grafts for inguinal hernia repairs in an ambulatory surgery unit were studied between January 1996 and October 1997. Xylocaine and Marcaine were used for local anesthesia. Deep sedation was maintained with intravenous Propofol after induction with Versed and Fentanyl. Some patients received Brevital and most were given Toradol to prolong analgesia. Total operating room time averaged 45 minutes. Narcotic use for pain relief averaged 2 days, and the majority were driving their cars in 6 days. Local anesthesia plus intravenous deep sedation has excellent patient acceptance and enables rapid patient recovery from inguinal herniorrhaphy.     

Day care and short stay surgery for hernia.

The duration of postoperative stay has been falling in recent years as more conditions are considered suitable for outpatient care. The introduction of short stay surgery not only relieves hospital waiting lists but also represents an economic advantage and has certain social benefits for the patient. The treatment of more patients as day cases reallocates the workload, putting increased responsibility on to outpatient clinics and general practitioner and community services. It also demands careful consideration of in-hospital operative and anaesthetic techniques to speed recovery and minimize complications.