LAPAROSCOPIC MESH REPAIR OF RECURRENT INGUINAL HERNIA

Background: Pre-peritoneal mesh repair has been a long-standing technique for recurrent hernias. Laparoscopic technique has been applied to this operation with the aim of assessing its results at early follow up of 1 year. Methods: The outcome in 56 patients was reviewed and all patients contacted 12 months after surgery. Results: There was one immediate failure at 1 week, needing a further operation. There were no other recurrences at 1 year. Ten patients had minor postoperative complications. Conclusions: At early follow up, this is a satisfactory technique for recurrent hernias.     

腹膜前Marlex网片植入法修补腹股沟复发疝

采用腹膜前Marlex网片植入法对21例腹股沟复发疝进行了修补。手术应用原切口入路的简化腹膜前修补法,显露腹股沟管壁结构,游离腹膜前间隙,植入Marlex网片。既能做到无张力修利,又能加强管壁结构。本组21例除1例术后皮下血肿,2例发生局部感觉异常外无其它并发症。随访2～5年无1例复发。作者认为,复发疝解剖层次改变、组织缺损重、瘢痕组织无弹性,采用传统方法修补易致复发;而采用人工假体植入则能有效防止复发。     

REPAIR OF GIANT INGUINOSCROTAL INGUINAL HERNIA USING MARLEX MESH AND SCROTAL SKIN FLAPS

A new technique for the repair of giant inguinoscrotal hernia is described. It consists of: reduction of the hernia; repair of the hernial orifices with marlex mesh; creation of a midline anterior wall defect to increase intra-abdominal capacity; covering this defect with marlex mesh; then covering the midline marlex mesh with a rotation flap of inguinoscrotal skin. This technique increases intra-abdominal capacity and allows reduction of the hernia without compromising respiratory function, in patients with chronic airflow limitation, by using skin that would otherwise be discarded.     

疝环充填式无张力疝修补术临床应用（附50例报告）

目的 应用疝环填充式无张力疝修补术修补腹股沟疝.方法 采用疝环填充式无张力疝修补术修补腹股沟疝50例,不切开疝囊,用锥形疝环填充物将疝囊推入腹腔,然后用补片平放于精索后方.结果 该技术较传统方法创伤小、无张力、疼痛轻、恢复快和并发症少.经术后随访和影像学观察,效果满意.结论 该方法可广泛应用于各种腹股沟疝的病人,尤其适用于老年和复发疝的病人.     

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。     

LAPAROSCOPIC EXTRAPERITONEAL INGUINAL HERNIA REPAIR USING A BALLOON DISSECTION TECHNIQUE

A laparoscopic extraperitoneal approach using a balloon dissection technique was used to repair 40 inguinal hernias in 35 patients. The initial experience with this method is presented. Thirty-four of these hernias were indirect, five direct and one sliding. Three were recurrent hernias. The operation time ranged from 40 to 135 min. Thirty-two of the patients stayed overnight in the hospital; Three stayed 2 nights. Return to normal activities ranged from 3 to 21 days. None of the patients had problems with nerve entrapment and to date there have been no recurrences of the hernias following the repairs. The procedure has been very well-tolerated by all patients.     

EVALUATION OF THE SAFETY OF INGUINAL HERNIA REPAIR IN THE ELDERLY USING LIGNOCAINE INFILTRATION ANAESTHESIA

Repair of inguinal hernia using local anaesthesia is becoming increasingly popular as it avoids many of the systemic side effects associated with general or spinaVepidural anaesthesia and provides excellent early postoperative pain relief. Dosages of local anaesthetic approaching the recommended maximum are frequently required for adequate anaesthesia of the inguinal region. The present study describes the disposition and safety of lignocaine with adrenaline in 14 elderly patients to ascertain its safety with a view to more widespread application of the technique in more complicated hernia repairs. Serial plasma lignocaine concentrations were determined for up to 24 h following doses approaching the recommended maximum for infiltration (7 mg/kg). Peak lignocaine concentrations (normalized to 7 mg/kg) ranged from 0.23 to 0.90mg/L (mean of 0.54mg/L): that is, the maximum recorded concentration was less than one-fifth the toxicity threshold for lignocaine of 5 mg/L. The study suggested that the majority of patients tolerated the local anaesthetic approach very well and that the wide safety margin allowed ample scope to develop the local anaesthetic approach for the repair of more complex hernia repairs (e.g. large, bilateral or strangulated herniae, or those in obese patients) without risk of exposing patients to lignocaine concentrations which may cause toxic side effects.     

INGUINAL HERNIA REPAIR: A COMPARISON BETWEEN LOCAL AND GENERAL ANAESTHESIA

Background : A comparative analysis of outcomes of inguinal hernia repair performed under local (LA) and general anaesthesia (GA) by a single surgeon using a standardized technique of anterior transversalis repair was performed. Ninety-three cases were examined, 56 of which were cases of LA hernia repair. Methods : A retrospective analysis of the patient hospital record was performed with particular attention to intra-operative and postoperative analgesia requirements. Results : An overall series complication rate of 6.5% (6/93) is reported. Only one of 56 LA patients (2%) required more than 24 h of narcotic analgesic injections compared to 11% (4/37) in the GA group (P < 0.05). The mean total postoperative parenteral narcotic requirement in the LA group was 86 ± 14 mg of pethidine as compared to the GA group who had a mean total requirement of 121 ± 17 mg of pethidine (P > 0.08). Conclusions : The LA infiltration technique is an effective method for inguinal hernia repair. This series demonstrates benefits in terms of length of hospital stay and a lower incidence of postoperative parenteral narcotic analgesic requirement although when postoperative parenteral narcotics were required by the LA group of patients, the difference in mean total pethidine requirement was not statistically significant.     

INGUINAL HERNIA REPAIR BY LAPAROSCOPIC SURGEONS: EARLY EXPERIENCE AND ATTITUDES

The introduction of laparoscopic inguinal hernia repair (LIHR) has been controversial. A questionnaire was sent to all general surgeons in New Zealand to document the early experience with LIHR and attitudes towards it. Of the 118 replies (response rate 55%). 74 were from laparoscopic surgeons. 26 of whom had performed 564 (201 public. 363 private) LIHR (23 bilateral) until January 1994. Only nine (35%) of these surgeons had assisted an experienced surgeon before performing an LIHR. and only four (15%) were supervised by an experienced surgeon during their first case. The transabdominal preperitoneal technique of LIHR was used by 14 (54%) surgeons. the extraperitoneal technique by eight (31%), and the tronsabdominal onlny technique by four (15%). There were 29 (5%) recurrences, 17 (3%) neuropathies. seven (1.2%) conversions, four (0.7%) miijor perforations. and one (0.17%) death. Of the 26 surgeons who performed LIHR, 20 (77%) were concerned about the absence of long-term results. 14 (54%) considered that the optimal technique had not been established. 13 (50%) were concerned about the unique complications associated with LIHR. 11 (42%) were less enthusiastic about performing LIHR than previously. 10 (38%) were doubtful about its advantages, and six (23%,) were uncertain about its future and considered that it should only be performed within the context of a controlled trial. This study highlights a number of issues that need to be addressed before the role of LIHR can be determined.     

GIANT INGUINAL HERNIA

Giant inguinal herniae present a major challenge in management. This case details clinical features of an enormous inguinoscrotal hernia associated with septic gangrene and elephantiasis of the scrotum. Two initial operations were required for control of sepsis, followed by a two-staged hernial repair, involving a total colectomy and a subsequent neoscrotal repair. The problems of loss of domain within the abdominal cavity and the special features presented by this case are discussed.