腹腔镜切口疝修补术与开放式切口疝修补术的比较研究

目的：比较腹腔镜切口疝修补术（LVHR）与开放切口疝修补术（OVHR）的临床疗效。方法：总结我院2005年1月-2011年1月治疗的腹壁切口疝（VIH）72例患者的临床资料,其中OVHR组32例,LVHR组40例。结果：OVHR组手术时间60～145min,平均手术时间（90±35）min;术中出血25～200mL,平均（95±15）mL;住院时间4～35d,平均（7．5±5．8）d,术区感染3例。LVHR组手术时间35～135min,平均手术时间（82±32）min;术中出血15～160mL,平均（854-12）mL,术区感染0例;住院时间3～8d,平均（5．5±1．6）d。患者随访3个月～5年,OVHR组复发2例（6．3％）,LVHR组复发3例（7．5％）。结论：LVHR同OVHR同样安全有效,但LVHR可明显降低切口感染并发症、减少术后疼痛、缩短术后住院时间。     

腹腔镜与开放疝修补术治疗腹壁疝的疗效比较研究

目的:评价腹腔镜腹壁疝修补术(laparoscopic ventral hernia repair,LVHR)与开放修补术治疗腹壁疝的临床应用效果。方法:回顾分析2010年5月至2016年8月收治的52例腹壁疝患者的临床资料,其中27例行LVHR,25例行开放手术。结果:两组手术时间[(65.4±18.7)min vs.(84.5±31.5)min]、术后住院时间[(6.3±1.8)d vs.(9.8±6.2)d]、术后第1天疼痛评分VAS[(3.4±1.1)vs.(6.4±1.5)]差异有统计学意义(P0.05),术后1周及1个月的疼痛评分差异无统计学意义(P0.05)。两组并发症发生率(22.2%vs.20.0%)差异无统计学意义(P0.05),腔镜组住院费用高于开放组(P0.05)。术后随访2~24个月,中位随访时间12个月,两组均无复发病例。结论:LVHR修补腹壁疝是安全、可行的,具有患者创伤小、康复快等优点,值得临床推广。     

腹腔镜辅助下小切口手术治疗腹壁切口疝的临床效果

目的分析腹腔镜辅助下小切口手术治疗腹壁切口疝的临床效果。 方法选择2017年1月至2019年1月南京市中西医结合医院收治的100例腹壁切口疝患者,对照组采用开放切口疝修补术,研究组应用腹腔镜辅助下小切口手术治疗,各50例,对比两组治疗效果。 结果研究组术中出血量（22.8±4.3）ml明显少于对照组的（51.7±5.6）ml,术后肛门排气时间、下床活动时间、住院时间均显著少于对照组,差异有统计学意义（均P<0.001）。研究组手术当天VAS评分为（5.7±0.6）分,术后1、2、3 d的VAS评分为（4.7±0.7）分、（2.8±0.5）分、（1.2±0.2）分,显著低于对照组同时间点评分,差异有统计学意义（均P<0.001）。研究组并发症发生率为4.0%（2/50）,低于对照组的22.0%（11/50）,差异有统计学意义（χ²=7.162,P=0.007）。 结论腹腔镜辅助下小切口手术可有效减轻腹壁切口疝患者的手术创伤和术后疼痛,降低并发症发生风险,从而缩短住院时间,加速患者恢复。     

腹腔镜完全腹膜外疝修补术与经腹腹膜前疝修补术治疗腹股沟疝的疗效

目的对比并分析腹腔镜完全腹膜外疝修补术（TEP）与经腹腹膜前疝修补术（TAPP）治疗腹股沟疝的临床效果。 方法选取2016年5月至2018年1月,攀枝花市中西医结合医院收治的腹股沟疝患者94例,根据手术方式的不同将其分为试验组及对照组,每组47例。试验组行TEP,对照组行TAPP。比较2组临床相关指标、术后疼痛情况,并统计2组术后并发症发生率及复发率。 结果试验组手术时间和发现对侧隐匿疝量分别为（52.38±9.76）min和2.13%（1/47）,与对照组（67.41±10.36）min和29.79%（14/47）比较,差异有统计学意义（t=7.239,χ²=13.406,P均<0.001）;试验组术后下床活动时间（3.04±0.72）d与对照组（3.28±0.89）d比较,差异无统计学意义（t=1.437,P=0.154）。自术前至术后2 d 2组疼痛视觉模拟评分（VAS）均呈下降趋势,差异有统计学意义（P<0.05）;但各时间点2组间VAS评分比较,差异无统计学意义（P>0.05）。试验组并发症患者4例,对照组6例,并发症发生率比较,差异无统计学意义（8.51% vs 12.77%,P>0.05）。试验组复发0,对照组复发1例（2.13%）,差异无统计学意义（P>0.05）。 结论两种术式各有优缺点,临床中需要根据患者具体情况选择合适术式,以保证手术效果。     

开放手术辅助腹腔镜与完全腹腔镜下修补术治疗腹壁切口疝的临床研究

目的探讨分析开放手术辅助腹腔镜与完全腹腔镜下修补术治疗腹壁切口疝的临床疗效和应用。 方法回顾性分析2016年1月至2018年6月在首都医科大学附属北京潞河医院普外科就诊并进行手术治疗的41例腹壁切口疝患者的临床资料。按照随机数字法表随机分为观察组和对照组。其中观察组20例,行开放手术辅助腹腔镜疝修补术;对照组21例,行完全腹腔镜下疝修补术。比较2组患者手术情况以及术后恢复、随访并发症情况。应用SPSS 21.0统计学软件进行数据处理。 结果观察组患者手术时间（106.81±33.90）min,术中出血量（14.05±7.85）ml,并发症发生1例（5%）;对照组分别为（126.75±23.36）min,（27.25±15）ml,3例（14.29%）,差异有统计学意义（P均<0.05）。观察组术后排气时间（2.05±0.51）d、住院天数（6.95±2.31）d,对照组分别为（1.71±0.64）d、（6.38±1.24）d,差异均无统计学意义（P均>0.05）。 结论开放手术辅助腹腔镜修补术治疗腹壁切口疝可明显缩短手术时间,减少术中出血,减少术后并发症的发生,效果显著,是一种安全有效的治疗方法。     

腹腔镜完全腹膜外疝修补术与腹腔镜经腹腹膜前疝修补术治疗腹股沟疝的疗效

目的比较腹腔镜完全腹膜外疝修补术（TEP）与腹腔镜经腹腹膜前疝修补术（TAPP）在腹股沟疝中的应用效果。 方法回顾性分析2015年2月至2018年1月，新津县人民医院收治的80例腹股沟疝患者的临床资料，根据手术方式不同将其分为试验组及对照组，每组40例。试验组行TEP，对照组行TAPP，2组均行为期1年的随访。比较2组手术临床指标、术后疼痛情况，并统计2组术后并发症发生率。 结果试验组手术时间及铺片耗时分别为（60.27±4.23）min及（25.31± 4.86）min显著短于对照组（73.18±5.62）min及（28.73±5.12）min，差异有统计学意义（t=11.608、3.064，P<0.001、P=0.003）；试验组住院时间及胃肠功能恢复时间分别为（3.38±0.78）d及（15.08±0.91）min与对照组（3.14±0.71）d及（14.79±0.83）min比较，差异无统计学意义（t=1.439、1.489，P=0.154、0.140）。自术前至术后5个月试验组及对照组VAS评分均呈下降趋势，差异有统计学意义（F=252.345、181.841，P均<0.001），且术后2及5个月各时间点VAS评分试验组显著低于对照组（t=4.135、4.711，P均<0.001），术前及术后1 d时间点试验组VAS评分与对照组比较，差异均无统计学意义（t=1.645、1.444，P=0.869、0.153）。试验组并发症发生情况2（5%）与对照组8（20%）比较，差异无统计学意义（χ²=2.857，P=0.091）。 结论腹腔镜全腹膜外自固定补片植入术较经腹股沟腹膜前补片植入术可有效缩短手术时间及铺片时间，且术后疼痛较轻、并发症发生率较低。     

杂交手术与腹腔镜下修补术治疗腹壁切口疝的临床研究

目的探讨杂交手术与腹腔镜下修补术治疗腹壁切口疝的临床体会。 方法回顾性分析2015年3月至2018年1月,苏州工业园区星湖医院普外科接受治疗的30例腹壁切口疝患者的临床资料。其中试验组患者14例,行杂交手术治疗;对照组患者16例,行腹腔镜下修补术。比较2组手术指标及术后疼痛情况。 结果试验组手术时间（175.63±21.15）min,与对照组（246.35±52.16）比较,差异有统计学意义（P<0.05）;试验组VAS评分、自主下床活动时间、术中出血量、住院时间、并发症发生情分别为（3.15±0.63）分、（2.49±0.35）d、（65.96±12.35）ml、（8.16±2.34）d及0,与对照组（3.65±0.52）分、（2.50±0.38）d、（66.34±13.52）ml、（8.26±2.18）d及2（12.5%）比较,差异均无统计学意义（P均>0.05）。 结论杂交手术治疗腹壁切口疝可明显缩短手术时间,且安全性好,具有较高的临床推广价值。     

两种手术方式治疗网塞型补片修补术后复发腹股沟疝患者的临床疗效

目的探讨腹腔镜经腹腹膜前疝修补术与腹腔镜完全腹膜外疝修补术治疗网塞型补片修补术后复发腹股沟疝患者的临床疗效。 方法选取2012年3月至2018年4月,苏州高新区人民医院普外科行网塞型补片修补术治疗后复发169例腹股沟疝患者为研究对象。通过查随机数表分为经腹膜组和全腹膜外组。经腹膜组再次行腹膜疝修补术,98例;全腹膜外组再次行全腹膜外修补术,71例。比较2组患者的手术相关指标、术后急慢性疼痛视觉模拟评分法（VAS）评分、并发症和复发情况。手术时间、术中出血量、VAS等为计量资料,使用均数±标准差（ ±s）来表示,组间比较使用独立样本t检验。复发情况、不良反应情况等情况为计数资料,以率表示,用χ²检验进行比较。 结果经腹膜组和全腹膜外组患者术后手术时间分别为（41.14±7.54）min、（42.53±4.55）min,差异无统计学意义（P>0.05）;全腹膜外组在术中出血量和术后住院时间分别为（15.14±4.51）ml、（6.70±1.50）min,与经腹膜组（12.94±4.08）ml、（5.10±1.30）min比较,差异有统计学意义（P<0.05）。全腹膜外组患者术后1、7、15和30 d后的VAS评分分别为（6.81±1.90）、（5.74±1.70）、（4.45±1.81）、（3.35±0.63）分,均低于经腹膜组（7.49±1.23）、（6.68±1.31）、（6.22±2.19）、（5.42±1.33）分,差异有统计学意义（P<0.05）。全腹膜外组复发率为0.70%,明显低于经腹膜组的4.59%,差异有统计学意义（P<0.05）。术后2组并发症血清肿、尿潴留、切口及阴囊水肿、切口感染指标比较,差异无统计学意义（P>0.05）;经腹膜组神经感觉异常13例（13.27%）明显高于全腹膜外组3例（4.23%）,差异有统计学意义（P<0.05）。 结论相较经腹膜疝修补术,腹腔镜下全腹膜外疝修补术治疗网塞型补片修补术后复发疝,术中出血小,术后恢复快,可有效缓解术后急慢性疼痛,神经感觉异常发生率及复发率低,具有临床应用优势。     

二种无张力腹股沟疝修补术治疗腹股沟股疝的疗效

目的研究经腹膜前间隙无张力腹股沟疝修补术与疝环填充式无张力腹股沟疝修补术治疗腹股沟股疝临床情况。 方法回顾性分析2013年1月至2017年1月,巴中市中医院因股疝而行开放式无张力修补术治疗患者的临床资料,共入选患者76例,其中34例患者行腹膜前间隙无张力修补手术,42例患者行疝环填充式无张力修补手术;观察2组患者的手术时间、手术后的恢复时间、住院的天数和费用,使用视觉模拟评分（visual analogue scale,VAS）手术后的疼痛,详细记录患者手术以后3、7、12、72 h后的疼痛评分情况和患者术后并发症情况。 结果2组患者在手术的时间、恢复时间和住院的天数方面比较,差异无统计学意义（P>0.05）;2组患者手术后3、7、12 h的VAS评分比较,差异无统计学意义（P>0.05）,术后72 h的评分比较,腹膜前间隙组（1.49± 0.43）分优于疝环填充组（2.32±0.52）分,差异有统计学意义（t=4.911,P=0.009）;腹膜前间隙组患者手术后的并发症情况优于疝环填充式组,其中慢性疼痛（1/34比14/42）、手术后异物感（0/34比16/42）比较,差异有统计学意义（P=0.013、0.005）。 结论经腹膜的前间隙无张力修补手术使用补片覆盖了患者整个的耻骨肌孔,是治疗腹股沟股疝更合理的手术方式。     

完全剥离疝囊与横断处理疝囊在腹腔镜经腹腹膜前疝修补术中的疗效

目的探讨完全剥离疝囊与横断处理疝囊在腹腔镜经腹腹膜前疝修补术（TAPP）中的应用效果。 方法选择2016年7月至2018年6月,如皋市中医院行TAPP的患者120例,分为试验组和对照组各60例。试验组行横断疝囊处理试验组,对照组行完全剥离疝囊。观察并比较2组患者的手术/住院相关指标、生活质量及术后并发症发生情况。 结果试验组患者的手术时间、术中出血量、疝囊处理时间、术后5 d腹股沟积液、住院费用及术后第2天的疼痛视觉模拟评分（VAS）分别为（47.11±4.15）min、（3.24±1.01）ml、（9.57±2.74）min、（5.27±1.09）ml、（8 105.69± 251.67）元及（2.11±0.97）分均低于对照组（57.69±5.28）min、（6.71±2.14）ml、（25.13±4.29）min、（13.75±3.56）ml、（11 241.55±397.52）元及（4.59±1.13）分,差异具有统计学意义（t=12.203、11.359、23.678、17.643、51.628、12.899,P均<0.001）;试验组患者的住院时间（6.51±1.04）d与对照组（6.19±1.06）d比较,差异无统计学意义（t=1.669,P>0.05）;术后6个月,试验组患者的健康状况调查简表（SF-36）评分及巴塞尔指数（BI）评分分别为（82.19±8.95）分及（83.01±7.94）分均高于对照组（75.11±8.02）分及（76.25±7.19）分,而改良Rankin量表（mRS）评分（73.19±7.02）分低于对照组（84.17±7.85）分,差异均有统计学意义（t=4.563、4.888、8.076,P均<0.001）;术后试验组患者的神经感觉异常和总的并发症发生情况分别为0及1（1.67%）,显著低于对照组5（8.33%）及11（18.33%）,差异均有统计学意义（χ²=5.217、9.259,P=0.022、0.002）;试验组患者血清肿发生情况为1（1.67%）与对照组6（10.00%）比较,差异无统计学意义（χ²=3.793,P=0.051）。 结论TAPP修补术中,与疝囊剥离相比,横断疝囊可以减少手术时间,减轻手术损伤、缓解术后疼痛,且并发症发生率较低,有助于患者康复,提高生活质量。     

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??Clinical control study of laparoscopic procedures vs open mesh repair for ventral hernias LI Jian-wen, XIE Yi-sheng, QIU Ming-yuan, et al. Department of General Surgery, Ruijin Hospital of Shanghai Jiao Tong University, Shanghai Minimally Invasive Surgery Centre, Shanghai 200025, China. Correspongding anthor: MAO Zhi-hai, E-mail:zhihaimao@163.com Abstract Objective To estimate the laparoscopic ventral hernia repair(LVHR), focusing on the safety and efficiency of the operations. Methods The clinical data of 68 patients with ventral hernias (defect≤20cm) performed hernia reparing between January 2007 and August 2008 at Ruijin Hospital of Shanghai Jiao Tong University were analyzed retrospectively. Results Thirty-one patients underwent laparoscopic repair (LVHR), and 37 patients underwent open mesh repair (OVHR). The clinical outcome was determined by a median follow-up of 11 months(1~21 months) for the two groups. No significant differences were noticed between the two groups in age, sex, body mass index (BMI), and hernia size. The mean operative time was (60.5±17.7)min for LVHR patients and (75.5±30.3)min for OVHR patients (P??0.017). The mean postoperative hospital stay was (6.2±2.5)d for LVHR patients and (9.6±8.0)d for OVHR patients (P??0.026). 96.8% of patients (30/31) were able to return to usual activity in 2 weeks for LVHR and 78.4% of patients (29/37) for OVHR (P=0.026). LVHR patients felt less pain in the first day after operation (P??0.018), and there were no significant differences in visual-analogue pain scores between the two groups afterward. Complications occurred in 19.4 % of LVHR patients and 24.3 % of OVHR patients (P =0.623) with a recurrence rate of 3.2% in LVHR and 5.6% in OVHR patients (P =1.000). The mean cost was (18334±5336) yuan RMB for LVHR patients and (9508±9222) yuan RMB for OVHR patients (P=0.000). Conclusion The short-term results indicate that laparoscopic technique is safe and effective for ventral hernia repairing with hernia defect less than 20cm.     

腹腔镜手术治疗老年腹股沟疝2771例分析

目的 分析老年腹股沟疝病人的临床特点,探讨腹腔镜治疗的合理性、安全性和有效性。方法 回顾性分析2001年1月至2016年12月在上海交通大学医学院附属瑞金医院接受腹腔镜腹股沟疝修补术（LIHR）的5050例病人（6047侧）的临床资料。其中＜65岁组2279例（2622侧）,65～80岁组2332例（2883侧）,＞80岁组439例（542侧）。结果 老年病人（65~80岁组和>80岁组,下同）的男/女比、手术史、双侧疝、直疝、复合疝、Ⅲ型疝、Ⅳ型疝（复发疝）比例高于中青年病人（<65岁组,下同）（P=0.000）。＞80岁组的经腹腔腹膜前疝修补术（TAPP）比例最高,65～80岁组的TEP比例最高。重量型补片（HWM）的使用和机械性固定的比例在＞80岁组最高,＜65岁组最低,三组差异有统计学意义（P=0.000）。随访时间18～60个月（中位时间36个月）。三组在单侧手术时间、术后第1天疼痛视觉模拟评分（VAS）评分、术后2周和4周恢复非限制性活动病例数等方面差异无统计学意义（P>0.05）。老年病人双侧手术时间长于中青年病人（P=0.001）,三组病人术后住院时间比较,＞80岁组最长,＜65岁组最短,差异有统计学意义（P=0.000）。共有13例复发（0.021%）病例,老年病人的复发率高于中青年病人（P=0.006）。并发症依次为血清肿、尿潴留、暂时性神经感觉异常和肠麻痹,其中,病人的尿潴留发生率＞80岁组最高,＜65岁组最低,三组差异有统计学意义（P=0.000）。结论 对于术前评估合格的老年腹股沟疝病人,LIHR是安全、有效、合理的术式。     

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??Analysis of 5050 cases of elderly inguinal hernia patients after laparoscopic inguinal hernia repair HAO Xiao-hui, HE Zi-rui, LI Jian-wen, et al.Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine; Shanghai Clinical Minimally Invasive Surgery Center, Shanghai 200025, China
Corresponding author??LI Jian-wen??E-mail??ljw5@yeah.net
Abstract Objective To investigate the clinical characteristics and outcomes of laparoscopic inguinal hernia repair(LIHR) in elderly patients and explore the rationality, safety and effectiveness of laparoscopic inguinal hernia repair. Methods The clinical data of 5050 patients (6047 hernias) underwent LIHR in Ruijin Hospital, Shanghai Jiao Tong University School of Medicine from January 2001 to December 2016 were analyzed retrospectively. Patients were categorized into 3 groups: 2279 (2622 hernias) nonelderly patients (<65 years old), 2332 (2883 hernias) elderly patients (65-80 years old), and 439 (542 hernias) octogenarian patients (>80 years old). Results Elderly and octogenarian patients had higher male/female ratio, more bilateral hernias, direct hernias, combined hernias, large hernias and recurrent hernias(P=0.000). Transabdominal preperitoneal prosthetic (TAPP) was the most favorable procedure in octogenarian group, whereas totally extraperitoneal prosthetic (TEP) was mostly performed in elderly patients. The use of high-weight mesh and mechanical fixation was the most in octogenarian group,and the less in nonelderly group, There were significant differences among 3 groups (P=0.000). The follow-up period was 18-60 months (median 36 months).There were no significant differences among 3 groups in terms of operation time for unilateral hernias, visual analogue scale (VAS) at 1st day after operation, and return to non-restrained activity time at 2??4 week after operation (P>0.05). The operation time for bilateral hernias was longer in elderly and octogenarian patients than in nonelderly patients (P=0.001), octogenarian patients have the longest hospital stay, while the nonelderly patients have the shortest (P=0.000). Thirteen cases of recurrence occurred (0.021%) during follow-up, and the rate was higher in elderly and octogenarian patients(P=0.006).The post-operative complications were seroma, urinary retention, paraesthesia and paralytic ileus, respectively. The rate of urinary retention was the highest in octogenarian group ,and the lowest in nonelderly group,the differences among 3 groups were significant(P=0.000). Conclusion LIHR is rational,safe and feasible for all the age groups. A comprehensive pre-operative evaluation is essential for elderly and octogenarian inguinal hernia patients.     

Tailoring surgical approach for elective ventral hernia repair based on obesity and National Surgical Quality Improvement Program outcomes

Background

Obesity's influence on postoperative complications in either laparoscopic ventral hernia repair (LVHR) or open ventral hernia repair (OVHR) has yet to be defined. Although 30-day postoperative complications increase with higher body mass index (BMI), we propose LVHR minimizes surgical site infections (SSIs) and surgical site occurrences (SSOs) for given BMI categories.

Methods

Retrospective review of the American College of Surgeons National Surgical Quality Improvement Program database (2009 to 2012) for patients aged 18 years or more undergoing elective ventral hernia repair. Exclusion criteria included immunosuppression, disseminated malignancy, advanced liver disease, or pregnancy. Patients were stratified by BMI (20 to 25, 25 to 30, 30 to 35, 35 to 40, and >40 kg/m²), and 30-day SSOs evaluated across BMI groups for LVHR vs OVHR.

Results

A total of 106,968 patients met inclusion criteria, with 60% patients obese. LVHR decreased SSO for all patients (odds ratio, .4; confidence interval, .19 to .60). Obesity classes I/II/III have increased odds of superficial SSI, deep SSI, and dehiscence for OVHR compared with LVHR. Only obesity class III has increased odds of organ space SSI and reoperation for OVHR vs LVHR (P < .05).

Conclusions

Obese patients are over-represented in VHRs. Thirty-day postoperative wound complications increase with higher BMI. LVHR minimizes both SSIs and SSOs, especially in higher obesity classes.     

Laparoscopic ventral hernia repair: pros and cons compared with open hernia repair.

BACKGROUND: The purpose of this study was to analyse the surgical techniques, perioperative complications, and recurrence rate of laparoscopic ventral hernia repair (LVHR), in comparison with the open ventral hernia repair (OVHR), based on the international literature. METHODS: A Medline search of the English literature was performed using the term "laparoscopic ventral hernia repair." Further articles were found by cross-referencing the references of each main article. RESULTS: Current literature on the topic suggests that LVHR is a safe alternative to the open method with the main advantages being minimal postoperative pain, a shorter convalescence period, and better cosmetic results. Main complications after the laparoscopic approach, such as incidental enterotomy, protracted pain, postoperative seroma, or mesh infection occur at an acceptable rate. Furthermore, most articles favor LVHR versus OVHR in terms of recurrence rate. CONCLUSIONS: Although further randomized studies are needed to draw safe conclusions in terms of complications and recurrence, LVHR is fast becoming the standard approach in the repair of abdominal wall hernias.     

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??Transabdominal partial extraperitoneal repair of lumbar hernia??A clinical study of 12 patients CHEN Xin??LI Jian-wen, SUN Jing??et al. Department of General Surgery??Ruijin Hospital??Shanghai Jiao Tong University School of Medicine; Shanghai Clinical Minimally Invasive Surgery Center??Shanghai 200025??China
Corresponding author??LI Jian-wen??E-mail??ljw5@yeah.net??ZHENG Min-hua??E-mail??zmhtiger@yeah.net
Abstract Objective To explore the safety and effectiveness of transabdominal partial extraperitoneal (TAPE) repair of lumbar hernia. Methods The clinical data of 12 patients with lumbar hernia underwent TAPE repair between May 2009 and July 2013 in Ruijin Hospital??Shanghai Jiao Tong University School of Medicine were analyzed retrospectively. Results The average size of the hernia defect was (81.3±43.9) cm2. The average size of the mesh employed was (266.7±103.0) cm2. There was no conversion to open surgery. The mean surgical time was (60.3±10.4) minutes. No intra-operative complications occurred. No patients need to take analgesic postoperatively. The mean VAS were 3.9±0.7 and 2.7±0.6 on the first day and the third day after surgery (POD1 and POD3) respectively. The mean postoperative hospitalization was (5.0±1.4) days. All patients returned to unrestricted activity within two weeks after surgery. During the follow-up period??no recurrence and complications were observed. Conclusion TAPE is a novel laparoscopic technique with safety and effectiveness for lumbar hernia repair. Its efficacy in short-term is certain.     

Current Trends in Laparoscopic Ventral Hernia Repair

Background and Objectives:

The purpose of this study was to analyze the surgical technique, postoperative complications, and possible recurrence after laparoscopic ventral hernia repair (LVHR) in comparison with open ventral hernia repair (OVHR), based on the international literature.

Database:

A Medline search of the current English literature was performed using the terms laparoscopic ventral hernia repair and incisional hernia repair.

Conclusions:

LVHR is a safe alternative to the open method, with the main advantages being minimal postoperative pain, shorter recovery, and decreased wound and mesh infections. Incidental enterotomy can be avoided by using a meticulous technique and sharp dissection to avoid thermal injury.     

青年腹股沟疝外科治疗策略

青年腹股沟疝的外科治疗较为复杂，Shoudice手术、Lichtenstein手术和腹腔镜腹股沟疝修补术（LIHR）等均为合理的术式。精子活力下降等并发症与技术操作有关而与术式无关。修补材料应选择轻量型补片或生物补片。青年男性大多为先天性斜疝，可合并隐睾、鞘膜积液、精索静脉曲张等其他先天性疾病，应制定个体化治疗方案。青年女性可合并子宫圆韧带囊肿，需与嵌顿股疝鉴别。子宫圆韧带囊肿切除和疝修补可在腹腔镜下同时完成，囊肿切除后是否须行预防性疝修补术有待于进一步探讨。青年女性建议保护子宫圆韧带，LIHR中可采用内环口成形术或腹膜切开再缝合术（T形切开）来保留子宫圆韧带。