Laparoscopic repair of an incarcerated obturator hernia

Obturator hernia is a rare cause of bowel obstruction. Occurring primarily in elderly women, it has a high incidence of incarceration and a high mortality rate. This report describes the successful laparoscopic reduction and repair of an incarcerated obturator hernia. Using open laparoroscopy, an incarcerated obturator hernia was diagnosed intraoperatively. After laparoscopic reduction, a transabdominal preperitoneal repair was completed using polypropylene mesh. The patient recovered uneventfully with no recurrence at 6 months. Laparoscopic techniques have been successfully applied to diagnose, reduce, and repair an incarcerated obturator hernia.     

腹股沟嵌顿疝患者急诊无张力疝修补术后护理体会

目的探讨腹股沟嵌顿疝患者急诊无张力疝修补术的术后护理体会。 方法选取2017年6月至2018年6月,万宁市人民医院收治的腹股沟嵌顿疝患者84例,均采用急诊无张力疝修补术,并按随机数字表法分为观察组及对照组,每组42例。观察组从患者心理、疼痛、下床活动、饮食、并发症、出院指导方面进行综合护理,对照组给予常规护理,2组术后随访6个月至1年。比较2组手术临床指标,入院及出院时焦虑自评量表（self-rating anxiety scale,SAS）,抑郁自评量表（self-rating depression scale,SDS）及视觉模拟评分（visual analogue scale,VAS）,统计2组术后并发症发生情况。 结果观察组术后进食时间、下床活动时间、住院时间显著短于对照组（P<0.05）。与入院时比,出院时2组SAS、SDS、VAS评分明显降低,且观察组明显低于对照组（P<0.05）。观察组并发症总发生率显著低于对照组（P<0.05）,2组复发率差异无统计学意义（P>0.05）。 结论腹股沟嵌顿疝患者急诊无张力修补术后给予针对性护理,可缩短患者住院时间,降低其术后焦虑及抑郁情绪、疼痛感、并发症发生率,促进患者康复,具有较好的临床应用价值。     

腹腔镜治疗儿童嵌顿性腹股沟斜疝的临床疗效

目的：观察腹腔镜治疗儿童嵌顿性腹股沟斜疝的安全性及有效性。方法回顾性分析2009年1月至2013年11月,佛山市第一人民医院行腹腔镜治疗的儿童嵌顿疝患者的临床资料。结果63例患者行腹腔镜探查治疗,麻醉后自行复位5例,58例麻醉下手法复位,其中中转开腹6例（9．52％）。手术时间10∽200 min,平均（45．7±35．9）min,出血量1∽5 ml,平均（1．5±1．0）ml,住院时间1∽15 d,平均（4．5±2．2）d。随访1∽48个月,无复发。结论腹腔镜治疗儿童嵌顿疝不但能清楚地观察疝内容物有无绞窄,而且处理较传统手术简单安全,并发症少,值得临床推广。     

Laparoscopic inguinal hernia repair in children.

BACKGROUND: This study aimed to document the authors' experience with laparoscopic inguinal hernia repair in children. METHODS: Ninety-three hernia repairs were performed in 64 children. The neck was closed with a purse string suture by using 4-0 absorbable suture. RESULTS: Ninety-three indirect inguinal hernial sacs were closed in 64 children. Nine percent of children had an ectopic testis. The mean operating time for laparoscopic ring closure was 25 minutes (range, unilateral 21 to 35; bilateral, 28 to 50). The contralateral processus vaginalis was patent in 20% of children. In 24% of children, the final procedure was modified based on the findings of a dilated internal ring. A laparoscopic ilio-pubic tract repair was done in these cases. Laparoscopic mobilization, orchiopexy followed by ilio-pubic tract repair was done in 9% of children. Scrotal swelling occurred in one child. Hydrocoele occurred in one patient. Recurrence rate was 3.1%. CONCLUSION: Laparoscopic inguinal hernia repair in children can be offered, as it is safe, reproducible, and technically easy for experienced laparoscopic surgeons. Ilio-pubic tract repair may be added in cases with dilated internal ring. Recurrence following laparoscopic ring closure can be managed with laparoscopic ilio-pubic tract repair. The long-term follow-up of laparoscopic ilio-pubic tract repair is awaited.     

Laparoscopic herniorrhaphy after manual reduction of incarcerated inguinal hernia

Background After a manual reduction (MR) of an incarcerated inguinal hernia (IIH), it is recommended that an open herniotomy (OH) be performed after a one-day delay because of the postincarceration tissue edema. We assumed that perfoming laparoscopic herniorrhaphy (LH) shortly after MR reduces the hospital stay for IIH. We compared LH with OH rectrospectively. We expected equal results but a shorter hospital stay with LH. Methods From May 2002 to April 2006, 40 successive patients with IIH were admitted. OH was scheduled two days after MR, whereas no delay for performing LH was required. Patients in whom MR failed and who required immediate surgery (n = 4) and patients whose medical condition prevented surgery within the schedule (n = 3) were excluded from the study. Follow-up consisted of an outpatient visit and telephone survey. Results Thirty-three patients (31 male, 15 OH, 18 LH) were included. For the LH patients, the median age was 15 (0.7–81) months and that for OH patients was 8.6 (0.6–61) months. For LH patients, weight = 11.5 (3.6–22) kg and for OH patients, weight = 9.8 (3.5–17) kg (p = NS). Median delay from MR to OH was 2 (2–4) days, and from MR to LH median delay was 1 (0–3) day (p < 0.05). Length of the operation was 29 (10–80) min in OH and 39 (20–60) min in LH (p = NS). Total theatre time was 44 (17–111) min in OH and 66 (44–86) min in LH (p < 0.05), and hospital time was 3 (3–6) days in OH and 2 (1–4) days in LH (p < 0.05). Median cost (surgery + hospitalization) of OH was €2315 (1910–3530) and that of LH was €3215 (2605–3650) (p < 0.05). Median follow-up was 26 (4–49) months, one patient (LH) had re-LH for recurrent hernia. Conclusion After MR, LH can be performed with minimal delay and similar results as OH. Despite increased theatre time and total hospital costs, LH shortened hospital stay.     

腹腔镜经腹腹膜前疝修补术与Lichtenstein术在成人腹股沟嵌顿疝的疗效

目的探讨腹腔镜经腹腹膜前疝修补术（TAPP）与Lichtenstein术在成人腹股沟嵌顿疝治疗中的临床应用比较。 方法回顾分析2014年1月至2019年1月,上海中医药大学附属普陀医院急诊收治并完成无张力疝修补手术病例共82例成人腹股沟嵌顿疝患者临床资料,根据手术方式不同分为2组。观察组38例,行TAPP术;对照组44例,行Lichtenstein术。将2组手术时间,术后住院时间,术后疼痛评分,术后血清肿,术后其他并发症（复发、术后感染、术后肠坏死、出血）,术后总费用等进行统计学分析。 结果2组在术后血清肿及其他并发症上比较,差异无统计学意义（P>0.05）;研究组手术时间及住院费用明显高于对照组,差异有统计学意义（P<0.05）;研究组术后住院时间及术后疼痛评分低于对照组,差异有统计学意义（P<0.05）。 结论TAPP术较Lichtenstein术手术时间长,术后总费用相对高,但其具有创伤小、疼痛轻、恢复快、复发率低等特点。     

Laparoscopic hernia repair in children by the hook method: a single-center series of 433 consecutive patients

Background

The relatively high recurrence rate reported in laparoscopic hernia repair in children using intracorporeal suturing technique remains a concern. We aimed to investigate the effectiveness of the hook method during hernia repair that allows extraperitoneal passage of suture to close the hernia sac without creating any tension or skip areas and does not require laparoscopic suturing skills.

Methods

A retrospective review was conducted on 433 consecutive children who underwent laparoscopic hernia repair using the hook method by 1 of 4 surgeons from July 2004 to June 2007.

Results

A total of 572 successful laparoscopic hernia repairs were performed among the 433 children with an age range of 1 week to 15 years (mean = 56 months). Conversion rate was 1.04%. Contralateral patent processus vaginalis was found in 26.8%. Mean operating time was 23.8 and 40.2 minutes for unilateral and bilateral repair, respectively. At a median follow-up of 20 months, there were 2 recurrences (0.35%), 2 hydroceles, 1 ascending testis, and 1 instance of testicular atrophy. No serious complications were associated with the procedure.

Conclusions

Medium-term results suggest that laparoscopic hernia repair with the hook method is a sound alternative to open herniotomy in children.     

脐外侧襞在腹股沟嵌顿疝修补术中应用的临床研究

目的探讨脐外侧襞疝修补手术在腹股沟嵌顿疝中的应用价值。方法选择腹股沟嵌顿疝并肠梗阻65例患者实施经腹疝内容物还纳，缝合疝囊颈口腹横肌，利用脐外侧襞对疝内口腹壁薄弱区域进行修补。结果62例患者成功进行手术，3例因肥胖脐外侧襞不明显，游离疝囊，缝合封闭内环口及周围腹；手术时间35～90min，平均56min；术后8～12h患者能下床活动，腹腔引流管均在术后2～4d内拔除，平均住院时间6．8d；所有患者无切口感染、肠漏、腹腔脓肿、腹膜炎、肠梗阻等并发症发生，康复出院。所有病例术后随访3～36个月，复查无复发。结论根据患者情况有选择经腹利用脐外侧襞修补腹股沟嵌顿疝是一种安全、有效、可行的方法，值得推广。     

Laparoscopic preperitoneal inguinal hernia repair without peritoneal incision

Summary More than 500,000 hernia procedures are performed annually in the United States alone. The authors have devised a new technique for laparoscopic hernia repair. The peritoneum is not incised, as the space between the abdominal wall and the peritoneum is developed with CO₂ and blunt dissection. The trocars and laparoscope are placed within this preperitoneal space. Mesh is stapled to Cooper's ligament and the underside of the abdominal wall. From November 1990 to January 1992, 68 herniae have been repaired in 35 patients. The first 25 patients were kept overnight for observation and discharged the following day. Thirty-two patients (92%) were able to resume full physical activity within 1 week. Average follow-up was only 12 months, but there were no recurrent or retained herniae.     

无张力补片修补治疗腹股沟嵌顿疝的临床观察

目的探讨无张力疝修补术治疗腹股沟嵌顿疝的临床效果。方法回顾采用无张力补片修补治疗的患者50例（观察组）和应用传统手术方法治疗的患者42例,分析两者的手术一般情况、术后并发症和复发率。结果两组患者的手术时间比较,差异无统计学意义（P〉0．05）,但是观察组患者术后下床活动时间、术后疼痛时间和住院时间均短于对照组,存在统计学差异（P〈0．05）。观察组患者并发症发生率为12．00％,明显低于对照组的35．71％,差异具有统计学意义（P〈0．05）。两组患者术后均随访18～24个月．观察组患者复发l例,复发率为2．00％,对照组复发8例,复发率为19．05％;传统手术的复发率明显高于无张力补片修补治疗者,差异有统计学意义（P〈0．05）。结论无张力补片修补治疗腹股沟嵌顿疝具有手术痛苦小、术后恢复快、复发率低、安全可靠．值得临床推广应用。     

Laparoscopic extraperitoneal repair of Amyand's inguinal hernia.

Amyand's hernia (appendix in the sac of an inguinal hernia) although rare is a fairly well-recognized clinical entity. It is associated with an increased risk of developing appendicitis. Amyand's hernia can be repaired by open or laparoscopic methods. We present the case of a laparoscopic extraperitoneal repair with a potential hazard when repairing this type of hernia in this manner, and we review the literature on this condition.     

警惕高龄患者隐匿性疾病诱发腹股沟嵌顿疝

目的分析高龄患者腹股沟嵌顿疝的临床特点。方法回顾性分析2013年1月至2014年1月,青海大学附属医院收治的腹股沟嵌顿疝高龄患者12例,分析12例高龄腹股沟嵌顿疝患者围手术期的诊断、治疗及预后。结果12例高龄腹股沟嵌顿患者中有5例患者合并有其他隐匿性疾病,其住院时间平均17d,均经积极手术治疗治愈出院。结论高龄腹股沟嵌顿疝患者,由于生理机能退化、临床表现不典型,往往合并隐匿性疾病,其诊断与治疗有其自身的特点。     

一孔法腹腔镜手术治疗小儿腹股沟嵌顿疝22例

目的：探讨一孔法腹腔镜手术在治疗小儿腹股沟嵌顿疝中的应用价值。方法 全麻后在腹腔镜辅助下手法复位嵌顿疝,采用一孔法行腹腔镜疝囊高位结扎术。结果 22例小儿嵌顿疝均行一孔法腹腔镜手术完成疝囊高位结扎,无手术并发症发生。18例患儿随访3～ 15个月,平均9.3个月,无复发,4例失访。结论 一孔法腹腔镜手术治疗小儿腹股沟嵌顿...     

优质护理模式在老年腹股沟嵌顿疝急诊手术中的应用

目的探讨优质护理模式在老年腹股沟嵌顿疝急诊手术中的应用效果。 方法选取2016年9月至2018年7月,琼海市中医院收治的腹股沟嵌顿疝老年患者116例,采用随机数字表法将患者分为观察组和对照组,每组58例。2组患者均行无张力疝修补术,对照组围手术期给予常规护理,观察组在此基础上采用优质护理模式。比较2组患者治疗前及出院后2周抑郁及焦虑状态、手术前后不同时间疼痛程度、住院期间护理质量及术后并发症发生情况。 结果与治疗前比较,出院后2周2组患者抑郁自评量表、焦虑自评量表评分均明显降低,且观察组明显低于对照组,差异有统计学意义（P<0.05）。术后6 h至3 d,2组患者视觉模拟评分均呈逐渐降低趋势,且术后6 h至3 d观察组VAS评分均明显低于对照组,差异有统计学意义（P<0.05）。观察组病情观察、护理技巧及并发症预防评分均明显高于对照组,差异有统计学意义（P<0.05）。观察组总并发症发生率明显低于对照组,差异有统计学意义（P<0.05）。 结论优质护理模式可以降低老年腹股沟嵌顿疝患者急诊手术后疼痛程度,缓解患者负性情绪,降低术后并发症发生风险,促进患者恢复。     

腹腔镜腹股沟疝修补术36例分析

目的 探讨腹腔镜腹股沟疝修补术的优点手术技巧及疗效.方法 2007-07～2009-07行腹腔镜经腹膜前补片植入术(transabdominal preperitoneal,TAPP)和伞腹膜外补片植入(totally extrperitoneal,TEP)共36例,其中腹股沟斜疝28例,腹股沟直疝5例,复合疝3例.结...     

TAPP在急性嵌顿性腹股沟疝中的应用体会

目的总结16例急性腹股沟嵌顿疝患者行腹腔镜腹膜前疝修补术(TAPP)的体会,探讨其应用技巧及价值。方法2007年8月至2009年8月对16例急性腹股沟嵌顿疝患者实施TAPP术,对其相关临床资料进行回顾性分析。结果本组手术全部成功,平均手术时间137.5 min,平均住院时间5.13 d。术后1例发生阴囊血清肿,1例发生腹腔脓肿,1例发生皮下气肿。随访6个月至2年无复发。结论熟练掌握TAPP的手术技巧,掌握好适应征,TAPP术可以安全、有效的应用于急性嵌顿性腹股沟疝患者。     

疝环充填式无张力疝修补术治疗腹股沟嵌顿疝

目的探讨疝环充填式无张力疝修补术治疗腹股沟嵌顿疝的临床效果. 方法采用美国巴德公司的聚丙烯锥形充填物及成型补片对45例腹股沟斜疝嵌顿施行疝环充填式无张力疝修补术. 结果手术时间48～98 min,平均75 min.术后12～24 h均下床活动.切口疼痛2～4 d.术后切口脂肪液化2例,排尿困难2例.术后住院3～10 d,平均5 d.39例随访5～18个月,平均12.5月,无复发. 结论疝环充填式无张力疝修补术具有安全、创伤小、恢复快、术后复发率低的优点,对嵌顿疝可Ⅰ期成功修补,临床效果满意.     

Laparoscopic approach to incarcerated inguinal hernia in children

Purpose

The purpose of this study was to describe the laparoscopic approach to incarcerated inguinal hernia in children.

Methods

After unsuccessful manual reduction, 29 patients (aged 3 weeks to 7 years; median, 10 weeks; 44 boys, 15 girls) with incarcerated inguinal hernia underwent immediate laparoscopy. The hernial content was reduced in a combined technique of external manual pressure and internal pulling by forceps. The bowel was inspected, and the hernia was repaired.

Results

In all patients, the procedure was successful. No conversion to the open approach was required. Immediate laparoscopic herniorrhaphy in the same session was added. No complications occurred.

Conclusions

Laparoscopy allowed for simultaneous reduction under direct visual control, inspection of the incarcerated organ, and definitive repair of the hernia. Technically, it appears easier than the conventional approach because of the internal inguinal ring being widened by intraabdominal carbon dioxide insufflation. The hospital stay is shorter.     

Laparoscopic extraperitoneal approach to acutely incarcerated inguinal hernia

Background: Laparoscopic treatment of acutely incarcerated inguinal hernia is uncommon and still controversial. Those being performed almost all use the transabdominal (TAPP) approach. The authors here present their experience with totally extraperitoneal (TEP) repair of acutely incarcerated hernia. Methods: A retrospective review was undertaken to evaluate the authors experience with this procedure over a 4-year period. There were 16 cases, 5 of which were performed using a conventional anterior repair. These 5 cases were excluded from the review. The surgery for all of the remaining 11 acutely incarcerated hernias was started laparoscopically using the TEP approach. Eight of the cases were completed this way, whereas three were converted to the open procedure. In addition to standard TEP repair techniques, a releasing incision is required for acutely incarcerated direct, indirect, or femoral hernias. With a direct hernia, the opening of the defect is enlarged to allow safe dissection of its contents. A releasing incision is made at the anteromedial aspect of the defect to avoid injury to the epigastric or iliac vessels. With an indirect hernia, several additional steps are required. The epigastric vessels may be divided; an additional trocar may be placed laterally below the linea semicircularis to facilitate dissection of the sac and to assist with suturing of the divided sac; and the deep internal ring is divided anteriorly at the 12 oclock position toward the external ring, facilitating dissection of the indirect sac. With a femoral hernia, a releasing incision is made by carefully incising the insertion of the iliopubic tract into Coopers ligament at the medial portion of the femoral ring. Results: The mean operative time was 50 min (range, 20–120 min), and the length of hospital stay was 5.4 days (range, 1–29 days). During a follow-up period of 9 to 69 months, there was no recurrence, and only two complications. One of these complications was an infected mesh that occurred in a case involving cecal injury. It was treated with continuous irrigation and salvaged. The other complication was a midline wound infection after a small bowel resection for a strangulated obturator hernia. Conclusions: Familiarity with the anatomy involved leads to the conclusion that the laparoscopic approach, specifically the TEP procedure, can be used without hesitation even in cases of acutely incarcerated hernia.     

部分可吸收平片在腹股沟嵌顿性疝修补术中的疗效

目的探讨部分可吸收平片在嵌顿性腹股沟疝中的临床应用方法、安全性及效果。 方法对2016年4月至2017年4月,大竹县人民医院收治的32例腹股沟嵌顿性疝行无张力疝修补术的临床资料进行回顾性分析。32例腹股沟嵌顿性疝全部采用部分可吸收平片行Lichtenstein修补术。每例均取局部渗出液送细菌培养（需氧）无细菌生长。 结果本组患者32例全部治愈,住院时间7～9 d,术后出现腹胀11例,阴囊水肿7例,无残端疝囊积液、阴囊血肿,全部患者随访4～14个月,无复发及慢性疼痛。 结论善释部分可吸收平片应用于嵌顿性腹股沟疝无肠坏死患者是安全、有效的。