Is prosthetic umbilical hernia repair bound to replace primary herniorrhaphy in the adult patient?

Abstract. Given the outstanding outcome that prosthetic repair has recently achieved in the repair of inguinal hernia, we wonder whether it should be implemented as the gold-standard technique for umbilical hernia repair. We report on 213 adult patients who underwent surgery for umbilical hernia at our Day Surgery Unit from June 1992 to January 1998. Criteria for exclusion included problematic social and family environment and ASA IV status. A polypropylene plug was placed in small umbilical defects, whereas large defects (>3 cm in diameter) were repaired with a polypropylene mesh. The mean follow-up was 64 months. The mean age was 57.1 years, with females accounting for the majority (57.8%). Most patients (88.3%) were classified as ASA I-II. With regard to the hernia size, 143 patients (67.1%) presented with small defects (<3 cm). The anaesthetic technique of choice was local plus sedation. Reported complications included seroma (5.6%), haematoma (2.3%), wound infection (1.4%), and intolerance to prosthesis (0.95%), the last causing recurrence. The overall recurrence rate at a mean follow-up of 64 months was 0.95%. Prosthetic umbilical hernia repair can safely be performed in adults, and the rate of recurrence in this study is low in comparison to primary tissue repair. Electronic Publication     

Late enterocutaneous fistula as a complication after umbilical hernioplasty

Umbilical hernia is a high-prevalence problem in adults. Traditional herniorrhaphy is marked by high recurrence rates, but nowadays, the use of prosthetic materials has improved results and has even brought about lower morbidity rates, making the enterocutaneous fistula an exceptional complication of umbilical hernioplasty. We report on a case of a 54-year-old male who developed a high-debt enterocutaneous fistula 1 year after undergoing an operation for an umbilical hernia by means of a plug-technique hernioplasty. We discuss the case, treatment, and preventable aspects of this complication.     

人工合成材料在成人脐疝治疗中的应用(附52例报告)

目的探讨人工合成材料在成人脐疝外科治疗中的应用价值。方法回顾性分析首都医科大学附属北京朝阳医院疝和腹壁疾病治疗中心2001年1月至2005年6月期间收治的52例成人脐疝的临床资料。分析成人脐疝采用人工合成材料治疗的方法、特点及效果。结果全部病例均痊愈出院，平均住院日10d（术后6d）。术后并发症包括伤口感染1例，局部皮瓣坏死1例，伤口皮下积液1例。随访2—54个月无复发。结论采用人工合成材料修补成人脐疝是一种安全、可靠的方法，应根据病人的情况，采用不同的补片和疝修补方式。     

侧方入路腹腔镜下完全腹膜外成人脐疝修补术5例经验

背景与目的：脐疝是较常见的腹壁疝之一,手术治疗是其唯一可治愈的治疗方法。随着腔镜技术的发展,腔镜在疝与腹壁外科的应用不断深入。本文旨在探讨经侧方入路腹腔镜下完全腹膜外脐疝修补术的可行性及安全性。 方法：2019年6月—2020年1月厦门大学附属中山医院普通外科为5例脐疝患者实施侧方入路的腹腔镜下完全腹膜外脐疝修补术,其中男3例,女2例;就诊时年龄30~53岁,平均41.8岁。回顾性分析该5例患者的临床病例资料及随访情况。 结果：5例均顺利完成手术;平均手术时间（70.2±5.8）min,术后6~8 h下床活动,术后平均住院时间（3.2±0.7）d;术后脐部积液1例,无出血、肠梗阻、肠瘘等严重并发症;随访1~7个月无复发。 结论：经侧方入路行腹腔镜下完全腹膜外成人脐疝修补术安全可行。侧方入路的手术方式操作难度相对较低,临床应用前景良好。     

Postoperative hematoma following inguinal herniorrhaphy: patient characteristics leading to increased risk

BACKGROUND: Although relatively infrequent, groin hematoma following inguinal herniorrhaphy is a morbid complication with major ramifications of mesh infection and hernia recurrence. We have sensed an increasing frequency of this complication in our tertiary referral practice and sought to determine whether or not significant risk factors could be identified. METHODS: In this matched case-control study (1995-2003), we identified 53 patients with groin hematomas and paired them with 106 age- and gender-matched controls. Patient and procedure characteristics were analyzed using chi-square and both univariate and multivariable, conditional logistic regression analysis. RESULTS: The 53 patients developing groin hematoma following inguinal hernia repair (mean age = 65, range 22-87, 90% male) were well matched with 106 controls (mean age = 65, range 22-87, 90% male). There was no significant difference in the location (left, right, bilateral), type (direct, indirect, pantaloon, first repair, or recurrent), or technique of hernia repair (Bassini, Lichtenstein, mesh plug, endoscopic, or McVay) between groups. While univariate analysis identified Coumadin usage (P < 0.001, hazard ratio 19.1), valvular disease (P < 0.001, hazard ratio 10.9), atrial fibrillation (P = 0.02, hazard ratio 4.2), vascular disease (P = 0.04, hazard ratio 2.2), blood abnormalities (P = 0.02, hazard ratio 3.2), and previous bleeding episodes (P = 0.02, hazard ratio 4.9) as significant factors, only preoperative Coumadin usage was important in multivariate analysis. CONCLUSION: The crucial risk factor for groin hematoma developing in patients undergoing inguinal hernia repair is preoperative need for Coumadin therapy. Although the perioperative management of anticoagulation in patients undergoing inguinal herniorrhaphy is not clearly defined, meticulous management of patients requiring Coumadin therapy seems prudent.     

改良式腹腔镜腹膜外补片植入法疝修补术

目的探讨改进式腹腔镜腹膜外补片植入法腹股沟疝修补术的可行性及临床意义.方法回顾性分析我院2002年6月～2004年10月13例腹股沟疝进行的腹腔镜下经腹腔腹膜外补片植入法联合腹膜缝合覆盖修补术的临床资料.其中腹股沟斜疝9例,直疝4例;其中复发疝1例;右侧8例,左侧4例,双侧1例.结果手术均获成功,单侧手术时间35～85 min,平均50 min,无一例中转开腹,无术后并发症,术后平均住院时间2 d,13例随访1～28个月,平均12个月,无一例复发.结论腹腔镜下经腹腔途径腹膜外补片植入法联合腹膜缝合覆盖术是一种安全、可靠、疗效显著的腹股沟疝修补方法,具有手术操作简单、创伤小、术后疼痛轻、恢复快等优点,可以代替开放手术,值得推广应用.     

Mesh在腹股沟疝修补中的应用

目的 探讨腹股沟疝的修补方法。方法 对18例腹股沟疝采用聚丙烯网片(Mesh)进行无张力修补。结果 18例手术均顺利，术后痛苦小、并发症少、住院时间短，随访11～23月，无复发。结论 采用Mesh修补腹股沟疝符合解剖生理，具有无张力、痛苦小、恢复快等特点。     

Current considerations in laparoscopic incisional and ventral herniorrhaphy.

Laparoscopic ventral and incisional herniorrhaphy is gaining popularity among both surgeons and patients. The key to the success of this procedure is avoidance of complications. In this article, important considerations in the preoperative, intraoperative, and postoperative aspects of this procedure are reviewed, with a particular focus on the repair of incisional defects. Surgical considerations to assist in the prevention of certain pitfalls associated with laparoscopic repair of ventral and incisional hernias are described.     

腹腔镜完全腹膜外疝修补治疗腹股沟疝260例报告

目的探讨完全腹膜外腹腔镜疝修补术（TEP）的安全性、可行性、有效性及手术方法。方法回顾分析2008年9月至2012年3月收治的260例（292侧次）腹股沟疝患者行TEP的临床资料。直疝50侧次,斜疝232侧次,复合疝10侧次。单侧疝240例,双侧疝20例,其中复发疝16例。结果 260例患者共行292侧次TEP。手术时间45-190min,平均单侧50min,双侧120min。术后使用镇痛剂10例。住院时间2-9d,平均（3.0±1.6）d。主要并发症为阴囊血清肿或血肿20例,术后尿潴留18例,腹股沟区疼痛8例,膀胱损伤1例。随访2-40个月,术后复发3例,为早期手术病例。结论 TEP具有安全可靠、术后疼痛轻、恢复快、术后疼痛发生少、远期舒适性好、复发率低等优势,应成为腹腔镜治疗腹股沟疝的主要术式点。     

Umbilical hernia in adults

Background: There is no consensus on the best technique for the repair of umbilical hernia in adults. The role of laparoscopic hernioplasty of umbilical hernia remains controversial. This study was undertaken to compare the outcomes of open and laparoscopic onlay patch repair of umbilical hernia in adults. Methods: From January 1996 to December 2002, 102 patients underwent elective repair of umbilical hernia. Operative techniques included Mayo repair (n = 43), laparoscopic onlay Gore-Tex patch hernioplasty (n = 26), suture herniorrhaphy (n = 24), and mesh hernioplasty (n = 9). Results: Demographic features and risk factors were similar among the four groups. The operative time of laparoscopic hernioplasty (median, 66 min) was significantly longer than those for patients who underwent Mayo repair (60 min) or sutured herniorrhaphy (50 min) (p < 0.05). None of the patients who underwent laparoscopic patch repairs required conversion to open repair. The median pain score at rest on postoperative day 1 was significantly lower in patients who underwent laparoscopic repair compared to those who had Mayo repair. A significantly shorter hospital stay and a lower wound morbidity rate were also observed in patients who underwent laparoscopic repair. With a mean follow-up of 2 years, suture herniorrhaphy had a relatively high recurrence rate (8.7%), whereas no recurrence was documented for the other techniques. Conclusions: Laparoscopic onlay patch hernioplasty is a safe and efficacious technique for the repair of umbilical hernia. Compared to Mayo repair, the laparoscopic approach confers the advantages of reduced postoperative pain, shorter hospital stay, and a diminished morbidity rate.     

无张力疝修补术后16例补片感染的临床分析

目的评价无张力疝修补术后补片感染的发生率、危险因素以及治疗方法。方法回顾性调查无张力疝修补术968例,分析术前、术中、术后的各种因素以及补片的感染率。结果 968例患者中有16例术后发生补片感染,补片感染率为1.65%。补片感染的危险因素:肥胖(P=0.029),糖尿病(P=0.010),疝的类型(P0.01),是否急诊手术(P=0.022),手术时间180min(P=0.012)。11例PPL补片(聚丙烯补片)感染中有7例运用了保守的治疗方法治愈,而e-PTFE补片(膨化聚四氟乙烯补片)以及复合补片的感染需要取出补片。结论产生补片感染的因素很多;有效的运用抗生素和引流可以解决大多数的聚丙烯PPL补片的感染,但膨化聚四氟乙烯e-PTFE补片需要及早的取出以解决补片感染。     

Ventral herniorrhaphy: Treatment evolution in a hernia service

Summary Between 1980 and 1996 the author operated at a teaching academic center and in a private hospital on 230 patients harboring ventral hernias. Fifty hernias were primary and one hundred eighty were incisional. Utilized techniques included direct tissue approximation or overlapping (N=35, recurrence rate 42%), ePTFE or polypropylene prostheses sutured to aponeurotic edges (N=147, recurrence rate 4.7%) and preperitoneal polyester prostheses (N=48, recurrence rate 2%). Nine wound infections occurred: three in clean, three in clean contaminated, and three in infected wounds, producing an overall 3.9 % infection rate. Thirteen markedly obese patients (Quetelet Index 31.9%) with gigantic multiply recurrent hernias offered a serious challenge requiring repeated procedures for recurrence, wound infection and mesh fragmentation. The technical transition leading to preperitoneal approaches utilizing polyester meshes lowered the overall complication rate and has become our procedure of choice until new prostheses are created.     

Laparoscopic versus open umbilical hernia repair.

BACKGROUND: The use of prosthetic material for open umbilical hernia repair has been reported to reduce recurrence rates. The aim of this study was to compare outcomes after laparoscopic versus open umbilical hernia repair. METHODS: We reviewed all umbilical hernia repairs performed from November 1995 to October 2000. Demographic data, hernia characteristics, and outcomes were compared. RESULTS: Of the 76 patients identified, 32 underwent laparoscopic repair (LR), 24 primary suture repairs (PSR), and 20 open repairs with mesh (ORWM). Preoperative characteristics were similar between groups. Hernia size was similar between LR and ORWM groups, and both were larger than that in the PSR group. ORWM compared with the other techniques resulted in longer operating time, more frequent use of drains, higher complication rates, and prolonged return to normal activities (RTNA). The length of stay (LOS) was longer in the ORWM than in the PSR group. When compared with ORWM, LR resulted in lower recurrence rates. LR resulted in fewer recurrences in patients with previous repairs and hernias larger than 3 cm than in both open techniques. CONCLUSIONS: LR results in faster RTNA, and lower complication and recurrence rates compared with those in ORWM. Patients with larger hernias and previous repairs benefit from LR.     

Current concepts on adult umbilical hernia

Summary Umbilical hernia has not received as much attention as other abdominal wall defects. Prevalence in the adult population is 2% and is much more common in cirrhotic patients and obese middle-aged multiparous women. Adult umbilical hernias have an acquired origin as a consequence of increases in pressure (pregnancy, ascites, etc.), the pull of the abdominal muscles, and the deterioration of connective tissue. Attention needs to be paid to the development of umbilical hernias after laparoscopic trocar insertion. All trocar sites larger than 10 mm should be properly closed after operation. The high morbidity and mortality associated with incarcerated umbilical hernias demand an elective repair in all circumstances. There is a lack of control trials evaluating the results of surgical repairs based on the tight overlapping closure of the umbilical ring described by Mayo, while recurrence after umbilical herniorrhaphy is thought to be a common event. The possibility of the application of biomaterials to the surgical correction of umbilical hernias that have been successfully used in the inguinal canal opens a new field for further clinical investigation. Control studies with long follow-up are now required in order to establish evidence based umbilical surgery.     

腹腔镜疝修补术治疗腹膜透析后并发腹股沟疝

目的探讨腹腔镜疝修补术治疗腹膜透析后并发腹股沟疝的可行性。方法对26例慢性肾功能不全、长期接受腹膜透析后并发腹股沟疝行腹腔镜下疝修补术，术中对斜疝行腹腔镜下内环口缝扎并在腹腔内置入网片，对直疝行腹腔镜下疝囊高位悬吊后腹腔内置入网片。结果26例均获成功，无中转开放手术，术后无阴囊血肿、顽固性神经痛等。26例随访6-12个月，平均9个月，疝无复发。结论腹腔镜疝修补术治疗腹膜透析后腹股沟疝可行，有效，安全。     

腹腔镜胆囊切除术联合脐疝修补术24例报告

目的探讨同时行腹腔镜胆囊切除术（laparoscopic cholecystectomy,LC）和脐疝修补术的可行性。方法回顾性分析2003年11月～2008年4月24例同时行三孔法LC和脐疝修补术的临床资料。于脐疝缺损处切开入腹,三孔法完成LC,Mayo法修补脐部缺损。结果24例手术均成功,手术时间35～65 min,平均48 min。术中出血量5～30 ml,平均16 ml。脐部切口无一例感染、皮瓣坏死。术后住院时间3～4d。24例随访1～54个月,平均28.6月,疝无复发。结论同时行LC和脐疝修补术可行、安全;较小缺损的脐疝Mayo修补法操作简单、效果满意。     

Initial presentation of coccidioidomycosis during inguinal herniorrhaphy

Coccidioidomycosis is a fungal infection endemic to the desert regions of the southwestern United States. Pulmonary symptoms predominate and are usually mild and self-limited. Dissemination is rare in the immunocompetent host. We present a case of disseminated, peritoneal coccidioidomycosis diagnosed during routine inguinal herniorrhaphy in an adult male. The current literature is summarized, and management recommendations are suggested.     

开放完全腹膜外疝修补术治疗老年完全性阴囊疝

目的探索开放完全腹膜外疝修补术（TEP）治疗老年完全性阴囊疝的临床应用价值。 方法回顾性分析2014年7月至2018年6月,广东省第二人民医院收治的106例老年完全性阴囊疝患者资料,分为开放TEP组和腹腔镜经腹腹膜前疝修补术（TAPP）组,观察2组患者手术时间、出血量、血清肿、阴囊积血、尿潴留、术后疼痛、术后谵妄、心肺并发症、术后住院时间、住院费用等情况,评价2组术式的疗效。 结果开放TEP组和TAPP组手术时间[（46.5±10.7）min vs（56.7±10.0）min]、住院费用[（8200.5±1599.7）元vs（12 031.7±735.6）元]、术后谵妄（0 vs 8.3%）及心肺并发症（0 vs 10.4%）分别比较,开放TEP组显著优于TAPP组,差异有统计学意义（P<0.05）。2组患者在出血量、血清肿、阴囊积血、尿潴留、术后疼痛、术后复发等方面比较,差异均无统计学意义（P>0.05）。 结论开放TEP术程时间短、费用较低,安全性可靠,效果肯定,可作为老年完全性阴囊疝的一种合理术式。     

平片无张力疝修补术治疗嵌顿性腹股沟疝(附45例报告)

目的探讨平片无张力疝修补术在治疗嵌顿性腹股沟疝的临床价值。方法回顾性分析平片无张力疝修补术治疗45例嵌顿性腹股沟疝的临床资料。观察其补片感染等并发症及复发情况。结果45例手术均顺利,无术后死亡。6例术后出现急性尿潴留,3例出现阴囊或切口血清肿,全部病人均获得随访,随访时间为3～40个月,无复发。结论用平片无张力疝修补手治疗嵌顿性腹股沟疝是安全而有效的,可避免二期再行修补术。     

腹腔镜脐环缝扎术治疗小儿脐疝的体会

目的:探讨腹腔镜脐环缝扎术治疗小儿脐疝的临床疗效。方法:回顾分析为21例脐疝患儿行腹腔镜脐环缝扎术的临床资料。结果:21例手术均获成功。手术时间20～45 min,平均32.5 min;术中均无出血,术后康复快。术后18例患儿随访6～72个月,无复发或肠粘连、肠梗阻等并发症发生。结论:腹腔镜脐环缝扎术治疗小儿脐疝安全、有效,手术微创、美观,值得推广应用。