Laparoscopic repair of Morgagni hernia with composite mesh in an elderly woman: Report of a case

A 78‐year‐old woman was admitted to another hospital with vomiting. Chest X‐ray showed an abnormal shadow in the lower right lung field, and CT indicated a Morgagni hernia containing the stomach and transverse colon. The patient was transferred to our hospital and underwent laparoscopic surgery. After the hernia contents were repositioned into the abdominal cavity, we repaired the hernia orifice with a prosthetic mesh to achieve a tension‐free repair. There were no complications after the surgery, and there has been no recurrence. The patient has remained free of clinical symptoms since 10 months after the surgery. Laparoscopic repair with a prosthetic mesh for Morgagni hernia is a simple and safety procedure for elderly patients.     

Laparoscopic mesh repair of parahiatal hernia: A case report

We report a case of a primary parahiatal hernia that was repaired laparoscopically with a composite mesh. A 51‐year‐old woman presented with vomiting and epigastric pain. CT scan showed a giant paraesophageal hernia with intrathoracic gastric volvulus. Intraoperatively, a diaphragmatic muscular defect was found lateral to an attenuated left crus of the diaphragm, distinct from the normal esophageal hiatus. The defect ring was fibrotic, making a tension‐free primary repair difficult. A laparoscopic mesh repair was performed with a composite mesh, which was covered with the hernia sac to prevent potential erosion into the esophagus or stomach. Recovery was uneventful and the patient was discharged on the 5 days postoperatively. She remained asymptomatic at subsequent follow‐up. Laparoscopic repair of parahiatal hernia can be safely performed. In circumstances where a large or fibrotic defect prevents a tension‐free primary repair, the use of a composite mesh can provide effective repair of the hernia.     

传统疝修补术与疝环充填式无张力疝修补术在腹股沟疝治疗中的应用体会

目的比较传统疝修补术与疝环充填式无张力疝修补术在腹股沟疝治疗中临床疗效。方法选取2006年2月至2010年12月期间住院的120例腹股沟疝患者,随机分为两组,对照组40例:采用传统修补术,治疗组80例:使用疝环充填式无张力修补术。对比分析两组手术时间、下床时间、住院时间、术后并发症和复发等情况。结果治疗组在下床活动时间、住院时间、术后并发症和复发率方面均优于对照组,差异具有统计学意义(P<0.01),在手术时间上无明显统计学差异(P>0.05)。结论疝环充填式无张力疝修补术具有住院时间短、创伤小、痛苦小、术后恢复快、伤口无感染、成功率较高、复发率低等优点,符合腹股沟解剖和生理结构,为目前腹股沟疝手术治疗的首选术式。     

Prospective randomized controlled trial comparing partially absorbable lightweight mesh and multifilament polyester anatomical mesh in laparoscopic inguinal hernia repair

Introduction

Tension‐free mesh repair is currently the gold standard treatment for inguinal hernia. Recent evidence has shown that both open and laparoscopic approaches to inguinal hernia repair can achieve good results. Lots of meshes with different properties are available on the market, but direct comparisons between them are scare. We conducted a prospective randomized controlled trial comparing a partially absorbable lightweight mesh (ULTRAPRO?) and a multifilament polyester anatomical mesh (Parietex?) in laparoscopic total extraperitoneal inguinal hernia repair.

Methods

This study was a single‐center, prospective randomized controlled trial to compare the surgical handling and clinical outcomes between two different types of meshes. All operations were performed using a standardized operative protocol. This study was approved by the Institutional Review Board of the Hong Kong East Cluster Health Service in 2009 (reference number: 2009‐087). The study was registered in the Australian New Zealand Clinical Trial Registry (ACTRN12610000031066).

Results

From October 2009 to August 2011, 85 laparoscopic total extraperitoneal inguinal hernia repairs were performed. The mean mesh handling time was 152 s for the ULTRAPRO group and 206 s for the Parietex group (P = 0.001). There were three cases of seroma formation in the ULTRAPRO group and nine in the Parietex group (P = 0.02). The overall recurrence rate was 2.5%.

Conclusion

It took less time to manipulate the flat mesh (ULTRAPRO) than the anatomical mesh (Parietex) in laparoscopic total extraperitoneal inguinal hernia repair, but the time difference was small. Lightweight mesh and heavyweight mesh offered similar clinical outcomes in terms of discomfort sensation and foreign body sensation during long‐term follow‐up.

     

Abdominal wall hernia mesh repair: sonography of mesh and common complications.

OBJECTIVE: The purposes of this study were (1) to review the sonographic in vitro and in vivo appearances of mesh for surgical repair of abdominal wall hernias, (2) to describe sonographic techniques and discuss the limitations of sonography in evaluation of mesh hernia repair, and (3) to illustrate common complications after mesh repair shown with sonography. METHODS: We identified interesting cases from the musculoskeletal sonographic database as well as from the teaching files of the authors, with surgical or other cross-sectional imaging corroboration. RESULTS: A compilation of the sonographic appearances of mesh used for anterior abdominal wall and inguinal hernia repair and complications diagnosable by sonography is presented. CONCLUSIONS: Sonography can be effective for evaluation of mesh and complications after mesh repair of anterior abdominal wall and inguinal hernias.     

Reoperation with laparoscopic mesh repair for recurrent lumbar hernia due to iliac crest bone harvest

Previous reports have described laparoscopic mesh repair for lumbar hernia due to iliac crest bone harvest, but there have been no reports of reoperation with laparoscopic mesh repair for recurrent cases after laparoscopic mesh repair. Here, we describe the case of a 72-year-old Japanese woman with lumbar hernia recurrence 6 years after laparoscopic mesh repair for lumbar hernia due to iliac crest bone harvest. We performed a successful reoperation with laparoscopic mesh repair. Laparoscopic surgery should be considered to elucidate the mechanism of recurrence, previous mesh position, and the area that must be covered to prevent recurrence again.     

疝环充填式无张力疝修补术治疗腹股沟疝122例临床体会

目的：总结疝环充填式无张力疝修补术的临床疗效和近期并发症。方法：应用美国巴德公司的疝环充填物及网状补片对122例各类腹股沟疝患者进行无张力疝修补治疗;对手术方法、手术时间、切口疼痛、术后自主能力的恢复、并发症、复发率及术中注意事项进行回顾性分析。结果：平均手术时间为46 m in;术后疼痛轻,15例口服止痛剂;术后平均8 h后下床活动;并发症6例,其中尿潴留4例,阴囊血肿2例,无切口感染。术后随访1~24个月,5个月后复发1例。结论：疝环充填式无张力疝修补术具有符合解剖生理、方法简单、创伤小、恢复快、术后并发症少、复发率低等特点。     

腹膜前间隙疝修补术与疝环充填式疝修补术治疗老年腹股沟疝患者的临床效果比较

目的比较腹膜前间隙疝修补术与疝环充填式疝修补术治疗老年腹股沟疝患者的临床效果。方法将80例老年腹股沟疝患者根据手术方案不同分为观察组与对照组,各40例。观察组采取腹膜前间隙疝修补术治疗,对照组采取疝环充填式疝修补术治疗。比较两组的治疗效果。结果观察组的手术时间、术后离床活动时间、术后疼痛持续时间、住院时间均短于对照组,术中失血量少于对照组(P<0.05)。观察组的异物感、切口感染发生率低于对照组(P<0.05)。观察组的术后复发率低于对照组(P<0.05)。结论腹膜前间隙疝修补术治疗老年腹股沟疝患者的临床效果显著,有利于降低并发症发生率及复发率,同时能够减少手术创伤并优化围术期指标。     

Laparoscopic repair of a large perineal hernia after laparoscopic abdominoperineal resection: A case report

A 75‐year‐old woman underwent laparoscopic abdominoperineal resection. Four months after abdominoperineal resection, the patient complained of a perineal bulge and urination disorder. Abdominal CT showed protrusion of the small intestine and bladder to the perineum. The patient underwent laparoscopic hernia repair with mesh. The size of the hernial orifice was 7.0 × 9.0 cm, and it had no solid rim. The mesh was tacked ventrally to the pectineal ligament and dorsally to the sacrum, and then sutured on the lateral side. The hernia has not recurred 10 months after the operation. Laparoscopic repair is a good treatment choice for secondary perineal hernia and fixing the mesh to the pectineal ligament, and the sacrum prevents the mesh from sagging.     

轻、重型聚丙烯网片植入腹股沟疝修补术后患儿疼痛及氧化应激反应的比较研究

目的 比较轻、重型聚丙烯网片植入腹股沟疝修补术后患儿术后疼痛及氧化应激反应的差异.方法 前瞻性选择2019年1月至2020年8月亳州市人民医院91例经腹股沟疝修补术治疗的患儿,按随机数字表法分为轻型组(n=45)和重型组(n=46).其中轻型组患儿给予轻型聚丙烯网片植入腹股沟疝修补术治疗,重型组患儿则给予重型聚丙烯网片...     

Gastric volvulus with a large bochdalek hernia in an adult successfully treated with emergency endoscopic reduction followed by elective laparoscopic mesh repair: A case study

We report a case of gastric volvulus with a large Bochdalek hernia successfully treated with emergency endoscopic reduction followed by elective laparoscopic mesh repair. The patient was a 71‐year‐old woman with no history of trauma. She was referred to our hospital because of nausea and vomiting after eating. Thoracic and abdominal CT showed gastric volvulus and a large Bochdalek hernia. The patient underwent emergency endoscopic reduction and elective laparoscopic surgery. The defect (10 × 12 cm) was reinforced with a Dual Mesh (expanded polytetrafluoroethylene) and fixed to the diaphragm with nonabsorbable sutures. The postoperative course was uneventful, and no complications or recurrence was found at the 2‐year follow‐up. The endoscopic reduction and elective laparoscopic procedure was performed successfully and resulted in significant clinical improvement in this case.     

无钉合完全腹膜外腹腔镜疝修补术(附32例次报告)

目的 探讨无钉合完全腹膜外腹腔镜疝修补术(TEP)的可行性和安全性.方法 自2007年1～6月在全身麻醉下行无钉合完全腹膜外腹腔镜疝修补术共32例次(26例患者),其中双侧腹股沟疝6例,斜疝25例,直疝7例.结果 手术全部成功,平均手术时间(76.8±23.8)min,平均术中出血量(8.3±4.6)mL,术后平均住院时间(2.7±1.2)d,恢复日常活动时间(5.2±1.3)d,术中腹膜破裂4例,术后阴囊血肿1例,无其他手术并发症.随访时间1～5个月,未见复发及腹股沟区慢性疼痛等并发症.结论 无钉合TEP是一种可行、安全、有效的无张力疝修补技术,能明显降低手术费用并获得最佳卫生经济学效益,可减少腹股沟区慢性疼痛症状的发生.     

Rutkow与Bassini修补术在老年腹股沟疝治疗中的比较及体会

目的比较疝环充填式无张力疝修补术（Rutkow法）与传统疝修补术（Bassini法）在治疗老年腹股沟疝中的临床效果,探讨如何提高Rutkow修补术临床效果。方法选择老年腹股沟疝患者116例,根据自愿的原则,其中46例分为对照组,采用Bassini修补术,70例分为观察组,采用Rutkow修补术,比较两组治疗的一般情况、术后并发症及复发情况;根据观察组不同的麻醉方式,也行上述比较。结果经比较得出,观察组与对照组在术后的一般情况、并发症及复发情况方面比较,具有显著性统计学意义（P〈0．05）;局麻组与硬膜外麻醉组在术后一般情况比较方面,具有显著性统计学意义（P〈0．05）。结论在老年腹股沟疝治疗中,条件允许时,应首选局麻下的疝环充填式无张力疝修补术（Rutkow法）治疗。此方法可缩短恢复周期,减少术后并发症及复发率,值得广泛推广。     

Laparoscopic intraperitoneal mesh repair of a large incisional hernia in a kidney transplantation patient: A case report

A 73-year-old woman presented to our hospital because of painful bulging in the right lower abdomen, and developed a 17 × 12 cm incisional hernia after kidney transplantation using right oblique incision. Laparoscopic intraperitoneal onlay mesh (IPOM) repair was performed. Since a transplanted kidney is close to the abdominal wall defect, the space between the transplanted kidney and the abdominal wall was peeled off to secure enough space for the mesh to be place. After that the fascial defect was detected precisely, and the polypropylene-polyglycolic acid composite mesh was fixed with 3 cm overlapping of the hernia ring by non-absorbable tacks. The patient was discharged 9 days after surgery. In general, abdominal incisional hernias after kidney transplantation are relatively large with boundary defect of abdominal wall ensuing between the abdominal and allograft. However, laparoscopic IPOM repair of incisional hernia after kidney transplantation can be performed safely and effectively.