输精管转位附睾吻合术治疗特殊梗阻性无精子症

目的 探讨应用显微外科技术施行输精管转位附睾端侧吻合术在特殊梗阻性无精子症治疗中的作用.方法 对梗阻性无精于症患者施行阴囊探查术,术中行精路通液试验确诊为特殊梗阻性无精子症14例,即一侧附睾梗阻或发育异常未检出精子而输精管通畅,对侧附睾检出活精子但输精管梗阻或发育异常.应用显微外科技术行输精管转位附睾吻合术,健侧输精管与对侧附睾检出活精子处吻合,术后随访其疗效. 结果 14例获随访7～31个月,9例于术后3～9个月从精液中检出活精子,复通率64%,5例配偶受孕成功,致孕率36%. 结论 显微外科输精管转位附睾吻合术治疗这种特殊梗阻性无精子症效果良好,值得临床推广.     

显微输精管交叉吻合术治疗复杂性梗阻性无精子症

目的探讨显微输精管交叉吻合术治疗复杂性梗阻性无精子症的临床疗效和安全性。方法 2012年11月~2014年12月通过显微输精管交叉吻合术治疗9例复杂性梗阻性无精子症。6例一侧由于疝手术损伤造成输精管缺损无法吻合,另一侧输精管近端通畅但附睾梗阻;3例一侧输精管进腹腔段梗阻,无法吻合,另一侧附睾梗阻,均进行显微输精管交叉吻合术:将一侧近端输精管通过阴囊中隔穿至另一侧阴囊,与另一侧远端输精管进行双层显微吻合。结果 9例均复通成功,复通率100%。1例在术后5个月再次梗阻。9例术后随访3~26个月,平均13个月,5例配偶自然受孕,术后均无不适和其他并发症发生。结论显微输精管交叉吻合术治疗复杂性输精管梗阻安全、有效,使既往只能通过睾丸穿刺进行辅助生殖的患者有自然生育的机会。     

显微横向两针套叠输精管附睾吻合术治疗附睾梗阻性无精子症

目的探讨显微横向两针套叠输精管附睾吻合术治疗附睾梗阻性无精子症的疗效。方法分析2011年3月至2012年9月期间收治的21例附睾梗阻性无精子症患者的临床资料。采用显微横向两针套叠输精管附睾吻合术治疗。术后每3个月复查精液1次,随访配偶受孕率。结果术后随访18～24个月,复通率为61．9％（13／21）,尾部和头体部吻合的复通率分别为66．7％（10／15）和50％（3／6）,配偶受孕率33．3％（7／21）。结论显微横向两针套叠技术治疗附睾梗阻性无精子症具备疗效显著和操作相对简化的优点。     

纵向两针套叠式输精管附睾吻合术治疗梗阻性无精症7例临床分析

目的分析输精管附睾吻合术治疗梗阻性无精子症的疗效。方法选取梗阻性无精子症不育患者7例,实施阴囊探查显微纵向两针套叠式输精管附睾吻合术进行治疗。术后第3个月开始每1～3月复查精液常规1次,随访配偶受孕率。结果回访时间5～47月,6例患者精液中发现精子,2例患者妻子成功受孕。结论选择适宜患者行纵向两针套叠式输精管附睾吻合术,值得临床推广与应用。     

附睾输精管吻合术治疗梗阻性无精子症

目的探讨附睾输精管吻合术在梗阻性无精子症治疗中的作用。方法选择23例确诊为梗阻性无精子症并初步怀疑为附睾水平梗阻的患者进行阴囊探查，观察睾丸、附睾及输精管情况，对其中19例确定为附睾水平梗阻并在附睾液中找到活精子的患者用8-0尼龙线施行双侧或单侧附睾输精管端侧吻合术，术后随访其疗效。结果19例获随访8～34个月，9例(47％)于术后3～9个月从精液中检出活精子，其中5例配偶受孕成功。结论阴囊探查简单、易行，有助于梗阻性无精子症的诊断和治疗，附睾输精管吻合术治疗梗阻性无精子症取得初步效果，值得进一步探讨。     

横向双针套叠显微输精管附睾管吻合术治疗梗阻性无精症

目的观察横向双针套叠显微输精管附睾管吻合术治疗梗阻性无精症的临床效果。方法我科自2007年5月至2007年12月选择6例确诊为梗阻性无精子症并证实为附睾水平梗阻的患者行横向双针套叠附睾管输精管吻合,即以10-0双针尼龙线在附睾管上横向缝合两针,将针以内进外出方式穿过输精管壁,然后在两针之间以显微刀横向切开附睾管,证实有精子后打结,8-0尼龙线缝合附睾浆膜和输精管肌层,术后随访6．13个月。结果4例术后精液分析可见精子,其中1例精液分析结果正常者生育一女;1例表现为少精症;2例表现为弱精症。手术成功率66．7％（4／6）。结论横向双针套叠显微输精管附睾管吻合术操作相对简单,疗效满意,不失为一种值得推广的阻性无精症治疗技术。     

机器人辅助输精管吻合术治疗梗阻性无精子症初步经验分析

目的:探讨机器人辅助下输精管-输精管吻合术(RAVV)及机器人辅助下输精管-附睾管吻合术(RAVE)的可行性及手术技巧。方法:2013年5月和7月我院收治2例梗阻性无精子症患者,1例为输精管结扎患者,行RAVV术;1例为双侧附睾梗阻患者,行RAVE术。结果:2例手术均顺利完成,术后共随访9个月,2例患者均于术后6个月时在精液中发现精子,精子浓度分别为2.0×106/ml、66.0×106/ml。结论:RAVV及RAVE具有吻合确切、视野清楚等优点,可以选择作为治疗梗阻性无精子症的手术方式。     

输精管附睾显微吻合术治疗梗阻性无精子症疗效分析

目的 探讨纵向2针套叠式输精管附睾显微吻合术治疗梗阻性无精子症的手术疗效.方法 对确诊为附睾水平梗阻的梗阻性无精子症25例施行纵向2针套叠式输精管附睾显微吻合术,术后随访复通率、配偶妊娠率.结果 术后随访25例,复通21例(84%);配偶妊娠17例(68%).结论 纵向2针套叠式输精管附睾显微吻合术治疗梗阻性无精子症是一种手术操作相对简便、疗效显著的外科技术.     

交叉输精管附睾显微吻合术治疗复杂梗阻性无精子症

正在男性不育患者中,无精子症的发病率约占10%~15%,其中梗阻性无精子症(obstructive azoospermia,OA)约占40%[1]。显微外科输精管吻合术、输精管附睾吻合术因其显著优势而成为近年来梗阻性无精子症的首选治疗[2]。然而有些复杂梗阻性无精子症,如单侧睾丸发育不良而对侧输精管缺如或多段梗阻,无法通过常规的同侧输精管或输精管附睾显微吻合术治疗,而施行交叉吻合可以     

腹腔镜辅助显微输精管吻合术治疗疝修补术后梗阻性无精子症(附5例报道)

目的探讨腹腔镜辅助显微外科输精管吻合术治疗儿童时期双侧疝修补术后梗阻性无精子症的可行性。方法回顾分析5例患者因儿童时期行双侧腹股沟疝修补术引起医源性梗阻性无精子症的临床资料,患者年龄25~34岁,术前诊断为无精子症;儿童时期均有双侧腹股沟疝修补术史,先予以腹腔镜经腹腔探查输精管,并在其辅助下将盆段输精管自腹腔从外环引出,显微镜下与近端输精管端端吻合。结果 5例患者均在腹腔镜辅助下完成双侧输精管显微吻合术,术后随访3~15个月,5例患者在3个月时复查均未发现精子,4例患者6个月精液中检出精子,精子浓度分别为18.75×10~6/m L,25.6×10~6/m L,20.15×10~6/m L和17.84×10~6/m L,精子总活力分别为14.6%,36.3%,29.2%和15.4%。其中2例患者配偶分别于术后12个月和15个月时成功受孕。1例患者随访至今查精液仍未见精子。结论有腹股沟疝修补术史的无精子症患者,应特别注意医源性输精管损伤的可能,腹腔镜辅助可帮助探查找到远端输精管,从而完成输精管端端显微吻合术。     

Intra-abdominal robot-assisted vasovasostomy of obstructive azoospermia in an Asian population following multiple bilateral inguinal herniorrhaphy in childhood: a case report and literature review

Iatrogenic injury to the vas deferens is an indication for vasovasostomy (VV). Various surgical approaches, including pure microsurgical VV (MVV), pelviscrotal laparoscopic-assisted VV (LAVV), and intra-abdominal robot-assisted VV (RAVV), have been reported to restore vasal patency. MVV is often faced a formidable challenge to provide tension-free VV due to an inadequate vas deferens length. Alternatively, pelviscrotal LAVV is much more effective for the identification and retrieval of the pelvic vas deferens prior to performing MVV. However, vasal laparoscopic mobilization could still be limited by insufficient vasal length for extracorporeal transfer in some cases. The addition of robotic assistance, on the other hand, allows the performance of “in-situ” vasal anastomoses and offers unique features compared with pure MVV/LAVV. However, few such approaches have been described in the literature. This study presents the initial results and validation of robot-assisted VV in an Asian population who had undergone triple herniorrhaphy. Briefly, Intra-operative findings demonstrated a large defect of the vas deferens, and a two-layer bilateral tension-free RAVV was performed to pursue the possibility of naturally achieved pregnancy. With our promising results, intra-abdominal RAVV may be described as a practical approach for cases with iatrogenic large defects of the vas deferens within the inguinal canal.     

Laparoscopic treated neuralgia after inguinal hernia repair: case report and literature review

Background: Neuralgia after inguinal hernia repair is a known but potential invalidating complication with a reported incidence of 10–12%. Diagnosis and treatment can be challenging. Based on a case report and literature review, disease aspects and treatment options including laparoscopic (triple) neurectomy are discussed.

Methods: A case of laparoscopic treated neuralgia after hernia inguinalis repair is reported. After an extensive MeSH-term based literature search, 26 articles were included for in-depth analysis and literature review.

Results: Pharmacotherapy encounters high numbers needed to treat and technical procedures often require re-intervention. Surgery should only be considered after one year of unsuccessful conventional treatment. Laparoscopic (triple) neurectomy is a minimal invasive procedure, providing optimal visualisation of the inguinal nerves. It is reported to be a safe and effective treatment option for refractory inguinal neuralgia.

Conclusions: Chronic neuralgia can be a severe complication after inguinal hernia repair. When pharmacotherapy and technical interventions are not sufficient, a laparoscopic (triple) neurectomy can be a promising, safe and effective treatment option.     

Mesh migration following repair of inguinal hernia: a case report and review of literature

New surgical procedures in the aftermath of their benefits beget new complications as well. Laparoscopic repair of inguinal hernia is widely practised now. It involves reinforcement of hernial defect with a synthetic mesh. We report a rare case of migration of mesh into urinary bladder following this mode of hernial repair. We also present a review of literature involving migration of mesh following all inguinal hernial repairs.     

Hemoperitoneum following inguinal hernia repair: a case report

Traditional inguinal herniorrhaphy continues to be one of the most common surgeries performed in the USA today. The procedure has developed into a straightforward, ambulatory procedure with postoperative complications being very rare. We describe the first report in the literature of the serious complication of hemoperitoneum after open inguinal hernia repair attributed to injury of the artery of Sampson.     

Preperitoneal herniation and bowel obstruction post laparoscopic inguinal hernia repair: case report and review of the literature

Laparoscopic inguinal hernia repairs, both transabdominal preperitoneal (TAPP) and total extraperitoneal (TEP), are associated with peritoneal defects or tears. Nonclosure of the tears can lead to bowel obstruction. I present a case of an early (48 h) bowel obstruction related to a peritoneal defect post TAPP inguinal hernia repair. The literature on peritoneal closure and bowel obstruction related to laparoscopic inguinal hernia repair is reviewed as well as options for repairing defects.     

Colonoscopic removal of inguinal hernia mesh: report of a case and literature review

The transabdominal preperitoneal (TAPP) procedure for laparoscopic inguinal hernia mesh repair is being applied with increasing frequency. This technique has an acceptable recurrence rate (0.4-3.9%), but has varying complication rates (1.3-17.4%).1,2 We report the first case of mesh penetration of the colon following laparoscopic TAPP repair, treated with colonoscopy.     

Non-developed external oblique aponeurosis in inguinal hernia repair: a case report and discussion of the literature

Open inguinal hernia repair is one of the most commonly performed operations in the world. It relies heavily on the presence of an inguinal canal formed by the external oblique aponeurosis and conjoint tendon. Variations of the anatomy of this region are rarely described. We describe a patient with bilateral inguinal hernias and missing external oblique aponeurosis. The patient underwent open repair secondary to previous abdominal surgery and the inability to obtain laparoscopic access. A medline search was performed and we provide a synopsis of the literature. At operation, no clear external oblique aponeurosis could be identified and large defects of the transversalis fascia were corrected. CT images of the anatomic variations are provided. To the best of our knowledge, combined abnormalities of the external oblique aponeurosis and transversalis fascia have not been described before.     

Herniorrhaphy with polypropylene mesh causing inguinal vasal obstruction: a preventable cause of obstructive azoospermia

OBJECTIVE: To report a multiinstitutional experience of men presenting with infertility secondary to inguinal hernia repair using polypropylene mesh. SUMMARY BACKGROUND DATA: An estimated 80% of inguinal hernia operations involve placement of a knitted polypropylene mesh to form a "tension-free" herniorrhaphy. The prosthetic mesh induces a chronic foreign-body fibroblastic response creating scar tissue that imparts strength to the floor and leads to fewer recurrences. However, little is known about the long-term effects of the polypropylene mesh on the vas deferens, especially with regard to fertility. METHODS: Eight institutions in the United States reported a total of 14 cases of azoospermia secondary to inguinal vasal obstruction related to previous polypropylene mesh herniorrhaphy. Patient characteristics and operative findings were forwarded to 1 center for tabulation of data. RESULTS: Mean patient age was 35.5 years with an average duration of infertility of 1.8 years. Mean number of years between urologic evaluation and herniorrhaphy was 6.3 years. Types of inguinal hernia repair previously performed were: open (10), laparoscopic (2), or both (2). Nine patients had bilateral obstruction and 5 patients had unilateral obstruction with contralateral testicular atrophy or epididymal obstruction. Surgical exploration revealed a dense fibroblastic response encompassing the polypropylene mesh with either trapped or obliterated vas in all patients. Surgical reconstruction was performed in 8 of 14 men (57%). CONCLUSION: Reconstruction to restore fertility can be difficult secondary to fibrotic reaction. Before undergoing polypropylene mesh herniorrhaphy, men, especially of young reproductive age or with a solitary testicle, need to be carefully advised of potential obstruction and compromise to future fertility.     

Laparoscopic repair of a spigelian hernia: a case report and literature review.

BACKGROUND: We present a case in which laparoscopy was both diagnostic and therapeutic in a patient with a spigelian hernia. CASE REPORT: A 35-year-old man was referred to the General Surgery Service for evaluation of right lower quadrant abdominal pain of approximately 6 months. The pain was not disabling but was a constant discomfort. The patient did not have any significant past medical or surgical history, and the physical examination was significant only for an area of focal tenderness in the right lower quadrant. Ultrasound and CT scans of the patient's abdomen were unremarkable. A laparoscopic exploration of the area revealed a defect in the area of semilunar and semicircular lines consistent with a spigelian hernia. The patient underwent a laparoscopic herniorrhaphy with placement of a polypropylene mesh. CONCLUSION: This case illustrates the role of laparoscopy in the diagnosis and treatment of spigelian hernias.     

Mesh erosion into caecum following laparoscopic repair of inguinal hernia (TAPP): a case report and literature review

Repair of inguinal hernia is the most commonly performed surgical procedure. Both open and laparoscopic methods are accepted modalities of surgical treatment. Transabdominal preperitoneal (TAPP) and total extraperitoneal (TEP) are the two types of laparoscopic repair of the inguineal hernia. The main advantages of laparoscopic repair, as compared to open repair, are a shorter hospital stay and a quicker recovery to normal activities. However, laparoscopic repairs are associated with a higher incidence of visceral and vascular injuries. One particular complication is the migration and erosion of mesh into the adjacent viscera. Although the total numbers of cases are small, compared to the total numbers of inguinal hernia repairs, they are important, as they often presented with a diagnostic dilemma. Most of the mesh migrations reported in the literature involves the urinary bladder. In this paper, we present a case of erosion of mesh into the caecum. The patient (a 66-year-old male) underwent TAPP repair of a right inguinal hernia in 1996 with polypropelene mesh. He also underwent an open appendicectomy in 1980. During the laparoscopic repair, he was found to have multiple intra-abdominal adhesions. He presented with intermittent diarrhea, for which he was investigated, and a benign caecal lesion was found. He was initially managed conservatively. However, his symptoms persisted and he underwent a right hemicolectomy in February 2006 in our hospital. The offending lesion was found to be the prolene mesh having eroded into the caecum.