无张力疝修补术在16例腹股沟嵌顿疝中的应用

目的 探讨无张力疝修补术在腹股沟嵌顿疝中的临床应用价值.方法 对我院2002年6月至2006年7月行疝环充填式无张力疝修补术治疗16例腹股沟嵌顿疝的临床资料进行回顾性分析.结果 手术全部成功完成,平均手术时间60 min,术后疼痛4例,2例出现阴囊积液.随访1～5年无复发病例.结论 疝环充填式无张力疝修补术治疗腹股沟嵌顿疝是安全有效的一种理想术式.     

无张力疝修补术治疗腹股沟嵌顿疝45例体会

目的:探讨无张力疝修补术治疗成人腹股沟嵌顿疝的临床效果。 方法：回顾性分析无张力疝修补术治疗45例腹股沟嵌顿疝患者（包括平片式修补Lichtenstein术12例、疝环充填式Rutkow术31例及经腹股沟切口Kugel腹股沟疝修补术2例）的临床资料。 结果：45例手术过程均顺利。无切口感染和排异反应，无术后死亡。所有患者术后3个月获得门诊随访，未见复发。 结论：无张力疝修补术在治疗成人腹股沟嵌顿疝有良好效果。     

疝环充填式无张力疝修补术在腹股沟嵌顿疝中的应用(附12例报告)

目的：评价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Bard Mesh perfix plug定型产品对12例腹股沟嵌顿疝患者施行疝环充填式无张力疝修补术，观察其疗效。结果：2例肠坏死行小肠切除吻合术；无术后死亡，12例均于术后1天下床活动。发生尿潴留2例。住院时间4－6d。全部随访1－23个月，无复发。结论：疝环充填式无张力疝修补术可应用于腹股沟嵌顿疝的治疗，且安全有效。     

应用疝环充填式无张力疝修补术治疗腹股沟嵌顿疝并小肠坏死手术体会(附21例报道)

目的评价应用疝环充填式无张力疝修补术治疗腹股沟嵌顿疝并发小肠坏死的手术效果。方法对于我院2001年5月至2009年5月期间收治的21例腹股沟嵌顿疝并发小肠坏死患者应用疝环充填式无张力疝修补术给予一期修补,先行坏死肠管切除,后置入网塞。结果无手术死亡病例,1例患者发生切口感染,经换药后治愈。平均住院时间6.5 d。全部患者随访6个月至8年,平均51个月,未见复发。结论疝环充填式无张力疝修补具有创伤小、安全及患者恢复快的优点,对于腹股沟嵌顿疝并发小肠坏死可以行一期修补,临床效果满意。     

无张力修补术在嵌顿性腹股沟斜疝、股疝中的应用

目的　探讨无张力修补术在治疗嵌顿性腹股沟斜疝、股疝中的价值。方法　回顾总结我院 1998年 2月～ 2 0 0 3年 8月行无张力疝修补术治疗嵌顿性腹股沟斜疝、股疝 3 7例患者的临床资料。其中腹股沟斜疝嵌顿 3 3例 ,股疝嵌顿 4例 ;行平片式无张力疝修补术 2 7例 ,疝环充填式无张力疝修补术 10例。结果　本组随访 3～ 60个月无手术死亡病例 ,无伤口感染 ,术后无复发。结论　无张力修补术是治疗嵌顿性腹股沟斜疝、股疝安全可靠的术式。对于被嵌顿内容物只要无脓肿形成、坏死肠管未破裂同样适合 ,避免了患者二次手术     

疝环充填式无张力疝修补术在腹股沟嵌顿疝中的应用

目的评价疝环充填式无张力疝修补术在腹股沟嵌顿疝的临床效果。方法采用mesh perfix plug定型产品,治疗19例腹股沟嵌顿疝病人,其中14例为60岁以上高龄,17例合并其它脏器严重病变,5例发生小肠嵌顿坏死。结果无术后死亡,仅1例术后发生阴囊血肿,除5例肠坏死行小肠切除吻合者外,病人术后2天可正常活动,无绞窄者住院时间为2～4天,发生绞窄者为6～7天,全部病人随访3～16个月,未见复发。结论疝环充填式无张力疝修补术具有安全、创伤小,恢复快的优点,同时,对发生绞窄者也可成功一期修补,临床效果满意。     

疝环充填式无张力疝修补术治疗老年腹股沟斜疝患者效果观察

目的总结疝环充填式无张力疝修补术治疗老年腹股沟斜疝(斜疝)患者的效果。方法选取2016-01—2017-01间在鹤壁市人民医院总院接受疝环充填式无张力疝修补术的58例老年斜疝患者,对其临床资料进行回顾性分析。结果 58例均顺利完成手术。手术时间35～52 min,平均41.67 min。术后首次下床活动时间2～4 d,平均3.51 d。术后住院时间4～6 d,平均4.72 d。术后并发尿潴留、腹股沟区异物感、切口血清肿各1例,均经对症处理后痊愈。术后随访18～24个月,其间1例(1.72%)复发。结论疝环充填式无张力疝修补术治疗老年斜疝患者,手术和住院时间短、患者痛苦轻,术后并发症少,复发率低,安全有效。     

无张力疝修补术治疗腹股沟斜疝96例

目的:评价无张力疝修补术在治疗腹股沟疝中的应用价值.方法:回顾性总结疝环充填式无张力疝修补术96例,其中可复性腹股沟斜疝85例,难复性疝7例,嵌顿性疝4例.结果:本组切口均一期愈合,术后3～7 d出院.随访1～48个月,无1例复发.结论:无张力疝修补术具有手术创伤小、术后恢复快、病人痛苦少、术后复发率低等优点.     

无张力疝修补术治疗嵌顿性腹股沟斜疝五例报告

疝环充填式无张力疝修补术是近年来在国内外广为应用的一种较先进术式。我们于２０００　年９月至２００１年４月应用无张力疝修补术治疗嵌顿性腹股沟斜疝５例，现报告如下。临床资料本组５例全部为男性，年龄２５～７３岁，平均６１岁。５例均为嵌顿性腹股沟斜疝，左侧３例，　右侧２例。２例为复发性。嵌顿至手术时间２～７２　ｈ，平均７．３　ｈ。２例伴有慢性支气管炎及前　列腺增生症，１例为高血压中风偏瘫患者。手术方法：５例全部实施疝环充填式无张力疝修补术，采用美国巴德公司ｍｅｓｈ　ｐｅｒｆｉｘ　ｐｌｕ　ｇ成套产品为修补…     

腹腔镜下疝内容物复位加疝环充填式无张力疝修补术治疗成人腹股沟嵌顿疝的临床应用

目的探讨腹腔镜下疝内容物复位加疝环充填式无张力疝修补术治疗成人腹股沟嵌顿疝的可行性及临床价值。方法回顾性分析我院2012年6月至2016年6月应用腹腔镜下疝内容物复位加疝环充填式无张力疝修补术治疗46例嵌顿性腹股沟疝患者的临床资料。结果全麻后有11例疝内容物自行回纳,腹腔镜下探查疝内容物均为小肠,其中1例小肠坏死,行部分小肠切除术。余35例患者成功行腹腔镜下疝内容物复位,其中2例大网膜坏死行部分大网膜切除术。所有患者腹腔渗出液WBC为1.32×10~9/L~78.81×10~9/L,平均(25.34±11.03)×10~9/L,疝囊周围渗液WBC为0.18×10~9/L~2.31×10~9/L,平均(0.42±0.28)×10~9/L。所有患者疝囊外周渗液涂片未找到脓细胞。术中腹腔镜探查发现合并对侧隐匿疝(斜疝)5例,予行疝环缝扎术,脂肪肝7例,肝囊肿14例,空肠憩室1例。全部病例顺利行疝环充填式无张力疝修补术。手术时间75~110 min,平均87.4 min。住院时间5~7 d,平均6.7 d。术后肠功能恢复时间15~36 h,平均20.4 h。术后5例出现血清肿、3例出现暂时性神经感觉异常。1例出现腹股沟区伤口脂肪液化坏死,加强伤口消毒、换药后伤口逐渐愈合。余病例无并发症。随访时间4个月至40个月,平均22.8个月,无术后疝复发。结论腹腔镜下疝内容物复位加疝环充填式无张力疝修补术治疗腹股沟嵌顿疝具有探查全面、及时复位、一期修补的优点,安全可行。     

Abdominal wall defects: pathogenesis,prevention and repair

‘Abdominal wall defects’ is a collective term used to describe two distinct pathologies: primary ventral hernias and incisional hernias. This article describes the pathogenesis, risk factors and the management of each.     

Groin hernias: features of recurrences

Summary In 2390 groin hernias operated on by the same surgeon there were 2327 inguinal hernias (97.4%) and 63 femoral (2.6%); 261 (11.2%) were recurrent hernias. The aim of this study was to define the different features of recurrences in a series of 206 recurrences operated on by an inguinal approach. The median time of recurrence was 3 years (< 1–58). It was < 1 year in 67 cases (40%) and 50% of all recurrences had occurred in 2.4 years. The time of recurrence after operation performed in childhood was 31 years (15–58). All recurrences were located in the area of the myo-pectineal and femoral orifices. There was only one site of recurrence in 125 cases (61%); the recurrence was direct in 73 cases (58%), indirect in 44 cases (35%) and femoral in 8 cases (7%). There were 2 sites of recurrence in 81 cases (39%), 76 mixed (94%) and 6 inguinal associated with a femoral hernia (6%). Altogether there were 288 sites of recurrence. There were 44 direct diverticular recurrences and 26 of these were located near the pubic tubercle. The rate of recurrence in current practice is much higher than that in specialized centers. The long delay of recurrence after simple resection of the sac in childhood constitutes an indirect argument for the Marcy procedure in adolescents and young men with type I or II hernias. The preeminence of direct recurrences and the existence of direct diverticular suprapubic recurrences are arguments for mesh procedures. The fact that all recurrences are located in the area of myo-pectineal and femoral orifices must be considered for the choice of a mesh procedure.     

Strangulated Small Bowel Obstruction Secondary to a Transmesosigmoid Hernia

Internal hernias are an infrequent cause of small bowel obstruction with transmesosigmoid herniation being very rare, especially in patients with no history of abdominal surgery or trauma. Early surgical intervention is important in acute presentation to reduce the high morbidity and mortality rates associated with this disease.     

Right paraduodenal hernia leading to bowel strangulation

Up to half of all internal hernias are caused by paraduodenal hernia, a rare congenital midgut malrotation that accounts for less than 1% of all intestinal obstructions. The diagnosis may arise from an incidental finding on abdominal imaging or the patient may present with abdominal pain, vomiting, and obstipation. Early recognition and management of this disease entity are keys because serious complications such as bowel ischemia and infarction may result from a delay in diagnosis. We present a case involving a 14-year-old boy with gangrenous small bowel secondary to right paraduodenal hernia.     

Do recurrences after paraesophageal hernia repair matter?

Background The recurrence rate for paraesophageal hernias (PEH) can be as high as 30% following laparoscopic repair. The aim of this study was to determine the severity of symptoms in patients with recurrences and the need for reoperation 10 years after surgery. Methods and Procedures Consecutive laparoscopic paraesophageal cases performed at a single institution between 1993 and 1996 were identified from the institution’s foregut database. Patients were asked about the presence and severity of symptoms (heartburn, chest pain, regurgitation, and dysphagia). Patients were also asked whether they had (1) been diagnosed with hernia recurrence or (2) undergone repeat surgical intervention. Results Complete follow-up was obtainable in 31 of the total of 52 patients (60%). The proportion of patients reporting moderate/severe symptoms was less at 10 years than preoperatively: heartburn 12% versus 54% (p < 0.001), chest pain 9% versus 36% (p = 0.01), regurgitation 6% versus 50% (p < 0.001), and dysphagia 3% versus 30% (p = 0.001). Two patients underwent repeat surgical intervention for symptomatic recurrences within the first postoperative year. Eight more patients have been diagnosed with hernia recurrences on either contrast esophagram or upper endoscopy but had not required reoperation. At ten years, more patients with hernia recurrence had heartburn than those who did not have recurrences (60% versus 14%; p < 0.05). Conclusions Despite a hiatal hernia recurrence rate of 32% 10 years after surgery, laparoscopic PEH was a successful procedure in the majority of patients; most remained symptomatically improved and required no further intervention 10 years after surgery.     

Retrocecal hernia preoperatively diagnosed by computed tomography: A case report

IntroductionRetrocecal hernia is a rare type of pericecal hernia. Because it is difficult to diagnose preoperatively, it is often treated with emergency operation.Case presentationAn 83-year-old male patient experienced sudden abdominal pain. Marked small bowel dilatation and intestinal obstruction were detected by abdominal computed tomography (CT). An enhanced CT scan also revealed a trapped cluster of small bowel loops behind the cecum and ascending colon. We preoperatively diagnosed small bowel ileus as a result of retrocecal hernia. After conservative therapy with a long intestinal tube, an emergency operation was performed. During the surgery, a portion of the ileum was found to be incarcerated in the retrocecal fossa. Intestinal resection was not necessary because the incarcerated ileum appeared viable, and the orifice to the hernia was opened. The patient was discharged without postoperative complications.DiscussionThe diagnosis of retrocecal hernia can often be confirmed intraoperatively. This disease is identified based on a minimal error in rotation with incarceration behind the cecum during the final phase of descent and fixation of the right colon or failure of cecal and retroperitoneal fixation. Early preoperative diagnosis is important to prevent intestinal ischemia, necrosis, and perforation and to reduce resection rates.ConclusionEarly preoperative diagnosis is important to avoid resection of the small intestine. CT scans are useful for preoperative diagnosis in case of retrocecal hernia.     

Laparoscopic treatment of left paraduodenal hernia in two cases of children

IntroductionThe paraduodenal hernia is an internal hernia that might cause a small bowel obstruction. The laparoscopic repair of paraduodenal hernia is sporadically reported for its safety, convenience, and patient's satisfaction.Presentation of caseWe performed the laparoscopic treatment of the left paraduodenal hernia in two children, a 3-months old boy and 12-year old girl. The girl had a left upper quadrant pain for one month with postprandial nausea after eating. The 3-months boy presented with an intermittent severe irritability. Small bowel series and computed tomography showed the left paraduodenal hernia in two patients. We successfully did the laparoscopic paraduodenal hernia repair using 5 mm and 3 mm laparoscope. They discharged within 5 days, uneventfully.DiscussionDespite of technical difficulties in pediatrics such as small working space and less pneumoperitoneum, the laparoscopic repair for paraduodenal hernia leads to patient's earlier intake of diet and rapid recovery with cosmetic satisfaction. The 3 mm laparoscopic repair needs longer operation time, but it is feasible in infants.ConclusionLaparoscopic repair of paraduodenal hernia in children and infants is safe and feasible. We recommend the laparoscopic repair as the first surgical option for paraduodenal hernia.     

Spigelian hernia in a child: case report and review of the literature

Abstract. Spigelian hernias (SHs) are rarely observed among children. The diagnosis is not difficult to make once it has been considered. The condition requires a high index of suspicion because of its high potential for life-threatening complications. A 12-year-old boy underwent open appendectomy for presumed acute appendicitis. A normal appendix found at laparotomy suggested another etiology for the acute abdomen. Incarceration of the greater omentum in a spigelian hernia was found, and the hernia repaired. The repair of pediatric SH is straightforward and utilizes endogenous tissues. Patients should be followed up for as long as possible to develop data on the durability of the repair technique selected. Electronic Publication     

Laparoscopic repair of complicated umbilical hernia with Strattice Laparoscopic™ reconstructive tissue matrix

INTRODUCTION

Complex hernias continue to present a challenge. Surgical techniques for repair are carefully considered to reduce risk for complications. Laparoscopic repairs improve postoperative infection rates, and placement of biologic mesh decreases mesh infection rates. However, laparoscopic repairs using biologic mesh is generally challenging due to difficulty with maneuverability.

PRESENTATION OF CASE

We present a case of a complex ventral hernia that was laparoscopically repaired using a new FDA cleared laparoscopic biologic graft. The patient had multiple comorbidities, including obesity, hepatitis C, endocarditis secondary to IV drug use, tobacco smoking, bilateral inguinal hernia, and recurrent umbilical hernia. The recurrent hernia was larger, irreducible, and discolored compared to original defect. The patient underwent laparoscopic repair with primary closure and reinforcement with Strattice™ Tissue Matrix Laparoscopic (LifeCell Corporation, Branchburg, NJ). At nine months postoperative, the patient had no evidence of recurrence, infection, or chronic pain, demonstrating early success from the surgical management.

DISCUSSION

Presence of multiple comorbidities and incarcerated recurrent hernia increase risk for complications during and/or after hernia repair. Considering these factors, laparoscopic repair with Strattice Laparoscopic and defect closure was a reasonable technique for repair.

CONCLUSION

Laparoscopic suture repair reinforced with biologic dermal tissue matrix was successfully performed during a complex hernia repair.