腹腔镜腹股沟疝修补术后血清肿的治疗

目的探讨腹腔镜腹股沟疝修补术后并发症之一血清肿误诊的原因及防范措施。方法回顾性分析我院2013年3月～7月开展腹腔镜疝修补术初期发生的对术后并发症误诊的两例患者的临床资料。结果两例患者均于住院期间接受了二次手术,术后恢复良好,未再见腹股沟区包块复现。结论腹股沟疝术后血清肿的存在符合正常转归过程,只有当血清肿成为并发症时才需对症处理。血清肿易与腹股沟疝复发／修补失败相混淆,认真查体,结合影像学检查可减少或避免其误诊。     

Predicting chronic post-operative pain following laparoscopic inguinal hernia repair

Background  Chronic post-operative pain (CPP) following laparoscopic inguinal hernia repair (LIHR) may cause significant morbidity and be more problematic than recurrence. Determining pre-operative risk may reduce morbidity. Our aim was to determine prevalence of CPP following LIHR and identify risk factors for its development. Methods  Data from patients undergoing LIHR (1996–2004) at one District General Hospital were collected, including demographics, body mass index, pre-operative pain, LIHR type (TEP or TAPP, primary/recurrent, unilateral/bilateral) and post-operative complications including CPP (pain lasting ≥1 year). Results  A total of 881 patients underwent LIHR (1,029 hernias). Of these, 523 (60%) patients completed the questionnaire, and 72/523 (13.8%) patients experienced CPP. Presence of pre-operative pain (P < 0.001), recurrent LIHR (P = 0.021) and age <50 years (P < 0.001) were significantly correlated with CPP. Conclusion  Chronic post-operative pain following LIHR is more prevalent than recurrence. Pre-operative pain, surgery for recurrent inguinal hernias (following anterior repair) and younger age at surgery predict development of CPP. Identification of ‘high-risk’ patients may improve management, reducing morbidity and cost.     

Pyoderma gangrenosum after inguinal hernia repair

Pyoderma gangrenosum (PG) is an uncommon, ulcerative skin disease that is often associated with systemic illness. In rare cases, PG occurs after surgery, which can lead to delayed diagnosis as other causes such as wound breakdown or bacterial/fungal infection are considered. We report a rare case of PG following the repair of an inguinal hernia, and review the presentation of this disease after surgery.     

Pseudo-recurrence after laparoscopic inguinal hernia repair

Aim-Background

Pseudo-recurrence after laparoscopic hernia repair, though known, is poorly understood. Common causes of pseudo-recurrence are pneumoscrotum, haematoma, seroma, cord thickening and persistent cough impulse.

Aim

To analyze the incidence of pseudo-recurrence and its impact on morbidity after laparoscopic inguinal hernia repair.

Methods

All laparoscopic inguinal hernia repair cases performed by a single surgical unit over a period of five years from April 2007 till March 2012 were retrospectively analyzed.

Results

Among 243 operated laparoscopic inguinal hernia repairs (TEP and TAPP) included in the study, twenty (8.26%) cases displayed a pneumoscrotum, eighteen (7.43%) a haematoma, twenty-four (9.98%) a seroma, eight (3.29%) cord thickening, and six (2.46%) persistent cough impulse. All patients were managed conservatively with the exception of one case of seroma which had to be aspirated.

Conclusion

Pseudo-recurrence following laparoscopic inguinal hernia repair, though common, has no significant impact on morbidity. Recognition of the problem is important to continue conservative management and avoid intervention.

     

Adhesions after laparoscopic inguinal hernia repair

Prosthetic mesh for laparoscopic inguinal hernia repair has become popular but the method of its placement is controversial. Mesh placed within the peritoneum may cause adhesion formation and further complications. The aim of this study was to examine the laparoscopic placement of a mesh, comparing intraperitoneal vs extraperitoneal insertion. In a porcine model (n=15) a polypropylene mesh was placed laparoscopically over the anterior abdominal wall. On the left side the mesh was stapled on the parietal peritoneum. On the right side the peritoneum was incised, an extraperitoneal space was dissected, the mesh was inserted, and the peritoneum was closed over it. The animals were maintained for 2 weeks. At postmortem there were adhesions in two of those placed extraperitoneally and five of those placed intraperitoneally (P=0.19, Fisher's exact test). The adhesions comprised fibrous peritoneal bands to loops of small intestine. Both methods of laparoscopic mesh placement were associated with a small but significant incidence of adhesion formation.Paper based on a communication to the European Association for Endoscopic Surgery in Cologne, Germany, June 1993     

Chronic pain after Kugel inguinal hernia repair

Background The incidence of chronic pain after Kugel herniorrhaphy is not well documented, since it was not used as a primary outcome measure in studies reporting on the Kugel technique. The aim of the present study was to report on the incidence and severity of chronic pain 1 year after Kugel herniorrhaphy and to identify the risk factors associated with the development of chronic pain. Methods The study population comprised all patients in our teaching hospital who underwent a Kugel inguinal hernia repair between January 2002 and June 2005. Postoperative complications, analgesia consumption and postoperative functional impairment were recorded during an outpatient clinic after 4–6 weeks. Chronic pain and cutaneous sensory changes were followed-up by means of a telephone questionnaire 1 year after surgery. Results After 1 year, 57 (15.1%) of 377 patients complained of mild to moderate pain. The incidence of mild and moderate chronic pain was 14.3 and 0.8%, respectively. None of the patients had severe chronic pain. Only one patient reported numbness in the groin area. Age and immediate postoperative pain were significant risk factors associated with chronic pain after Kugel inguinal herniorrhaphy. Although the difference was not significant, female patients seemed to be more prone to develop chronic pain. Conclusions The Kugel inguinal hernia repair is associated with a low rate of postoperative chronic pain. The minimally invasive preperitoneal approach of the Kugel technique probably causes less nerve damage and subsequent neuropathic pain. Chronic pain seems to be more common in young female patients with immediate postoperative pain.     

Return to work after inguinal hernia repair

BACKGROUND: There is much variation in the time when a patient returns to work after inguinal hernia repair. Most surgical research has focused on the type of operation performed, but other factors may be equally or more important. This study attempted to identify these factors. METHODS: We prospectively studied the return to work after inguinal hernia repair in a convenience sample of 235 patients who were operated on by one surgical group. Ninety-three of these subjects, who were working and had complete data, were included in this analysis. Data were gathered through personal interviews, written surveys, and medical record reviews. The main outcome measures were actual and expected return to work. RESULTS: Primary tissue repair was done in 94% of the patients. The mean age was 49 years; 90% were male. The expected return to work was 10 days; the actual mean return to work after operation was 12 days (median, 7 days; range, 2 to 60 days) and was unrelated to preoperative functional status. Bivariate analysis showed that age, educational level, income level, occupation, symptoms of depression, and the expected return to work accounted for 61% of the variation in actual return to work. CONCLUSIONS: Factors other than operative technique, including patient expectations, are strongly associated with return to work after inguinal hernia repair. Depression significantly delayed return to work. More research is needed to understand how expectations are formed and how decisions are made regarding return to work, and whether these can and/or should be influenced by surgeons, employers, or others to promote earlier return to work.     

Pain characteristics after laparoscopic inguinal hernia repair

Background  

Previous studies have shown different pain characteristics in different types of laparoscopic operations, but pain pattern has not been studied in detail after laparoscopic inguinal hernia repair. To optimise preoperative patient information and postoperative analgesic treatment the present study investigated postoperative pain in terms of time course, pain intensity and individual pain components during the first 4 days after transabdominal preperitoneal hernia repair (TAPP).     

无张力腹股沟疝修补术后并发症的防治探讨

股股沟疝占腹外疝的 90 %以上[1] ,以往一直沿用Ｂａｓｓｉｎｉ等传统的手术方法 ,术后病人痛苦大 ,恢复慢 ,其复发率高达10 % [2 ] 。自 2 0世纪 80年代末 ,Ｒｕｔｋｏｗ和Ｒｏｂｂｉｎｓ开始采用“ｍｅｓｈｐｌｕｇ”进行无张力腹股沟疝修补术以来 ,该术式逐渐得以推广、普及。我院自 1998年 6月至 2 0 0 0年 12月共对 2 2 4例腹股沟疝患者采用了无张力腹股沟疝修补术 ,现就其中出现的 18例术后并发症进行分析。1　临床资料1 1　一般资料　腹股沟疝 2 2 4例 ,男 2 0 6例 ,女 18例 ,年龄2 1～ 92岁 ,6 0岁以上病人 142例 ,占 6 3 2 %。原发…     

腹股沟疝修补术后血清肿的研究进展

血清肿作为腹股沟疝修补术后常见的并发症,由于不同学者对于血清肿理解认知不同,导致报道的腹股沟疝修补术后血清肿发生率差异较大。患者因素、医师的经验以及补片材质、固定方式等均是患者术后形成血清肿的重要原因;在治疗方面,大多数情况下血清肿可无需临床干预即可自行吸收,仅当患者出现严重症状、感染等少数情况下进行临床干预。因此,对于降低围手术期血清肿的发生率仍需以预防为主。笔者就腹股沟疝术后血清肿的研究文献作一综述,以期为临床提供参考。     

腹股沟疝修补术后复杂性区域疼痛综合征

疼痛是临床实践中最常见的问题之一,在外科领域更为普遍.但是有些疼痛的发病机制比较复杂,治疗困难,临床称为复杂性区域疼痛综合征(complex regional pain syndrome,CRPS).腹股沟疝手术后疼痛的发生率也不低,严重影响患者的生活质量,得到学术界的高度重视,是临床处理的一个难点.     

Patient survey after inguinal hernia repair in ambulatory surgery

We studied the patient charts of six women and 41 men who had undergone hernia repair in ambulatory surgery between February 1991 and March 1992, and sent a postal questionnaire to all 47 former patients. No major complications had occurred. The response rate was 92% (n = 43). We discovered that 95% of respondents felt that preoperative instructions had been adequate, but only 38% felt that they had received adequate postoperative information. Postoperative pain was considered to have been severe by 43%. Full activity had been resumed after an average of 28 days. Overall, 86% claimed to be satisfied, and 67% said that they would recommend hernia repair in ambulatory surgery to others. We conclude that hernia repair in ambulatory surgery can be performed safely. Nevertheless, more attention has to be paid to providing information for postoperative life rules and analgesia to enhance patient satisfaction.     

Acceptable nationwide outcome after paediatric inguinal hernia repair

Purpose

The primary objective was to describe 30-day outcomes after primary inguinal paediatric hernia repair.

Methods

Prospectively collected data from the National Patient Registry covering a 2-year study period 1 January 2005 to 31 December 2006 were collected. Unexpected outcomes were defined as either/or hospital stay for >1 day (i.e. 2 nights at hospital or more), readmission within 30 days, reoperations within 12 months after repair including repair for recurrence, and death within 30 days after repair.

Results

The study cohort comprised 2,476 patients, and unexpected outcome was found in 267 patients/repairs (10.8 %). Prolonged hospital stay was by far the most prevalent indicator of unexpected outcome. Prolonged hospital stay was in 8.2 %, readmission in 2.1 %, reoperation in 0.7 %, and complications were observed in 1.1 %. One patient died within 30 days after repair, but death was not associated with the inguinal hernia repair. The usual technique was a simple sutured plasty (96.5 %). Emergency repair was performed in 54 patients (2.2 %) mainly in children between 0 and 2 years (79.6 %). During the 1 year follow-up, reoperation for recurrent inguinal hernia was performed in 8 children after elective repair (recurrence rate 0.3 %). Paediatric repairs were for most parts performed in surgical public hospitals, and most departments performed less than 10 inguinal hernia repairs within the 2 years study period.

Conclusion

These nationwide results are acceptable with low numbers of patients staying more than one night at hospital, low morbidity, and no procedure-related mortality.     

Chronic pain and discomfort after inguinal hernia repair

Purpose

The purpose of this study was to estimate the incidence and degree of persistent chronic pain after inguinal hernia repair performed in our hospitals.

Methods

We mailed a questionnaire on the frequency and intensity of postoperative inguinal pain and discomfort to 219 adult patients who had undergone inguinal hernia repair in one of our hospitals more than 3?months previously.

Results

There were 191 (87.2%) respondents, 28 (14.7%) of whom reported pain and 33 (17.3%) reported discomfort. The frequency of pain was “rare” in more than half of the patients who reported pain. No patient reported “continuous” pain. The intensity of the pain was “mild” in most of the patients, and none reported “pain that required a painkiller”. The answers on the face scale questionnaire (score “0” to “10”) were “0” or “1” for most of the patients. The incidence of chronic pain and/or discomfort was significantly higher in women than in men, and tended to be higher in patients who had undergone repair using onlay mesh.

Conclusions

The frequency and intensity of persistent chronic pain or discomfort after inguinal hernia repair was not high or severe. These data will be useful for further studies to determine the best treatment for adult inguinal hernia.     

Late-onset deep mesh infection after inguinal hernia repair

Background Groin sepsis requiring mesh removal is said to be a rare complication of tension-free inguinal hernioplasty. Furthermore, late-onset deep-seated prosthetic infection seems to be an unexpected complication. The aim of this study was to report our experience on late mesh infection occurring years after open hernia repair. Methods Between 1998 and 2005, 1,452 patients (954 men), median age 64 years (range 19–89) underwent groin hernioplasty using a tension-free polypropylene mesh technique. Five patients (0.35%) appeared with late mesh infection (between 2 and 4.5 years postoperatively). The patients’ records were retrospectively reviewed for the purpose of this study. Antibiotic prophylaxis had been given in the five patients, while none of them had a prior history of wound infection. Results The patients were re-operated and the meshes were removed. Pus was found in three patients and Staphylococcus aureus was isolated in one. There was no hernia recurrence and none of the patients had chronic groin pain for a period of 6–44 months postoperatively. Conclusion From the results of this study, it appears that late-onset deep-seated prosthetic mesh infection is an important complication which has been rarely reported upon. Its true incidence is yet to be established. Late graft infection does not seem to correlate to neither the administration or not of antibiotic prophylaxis, nor to the presence or not of previous superficial wound infection. Furthermore, graft infection does not seem to correlate to neither the type of mesh inserted, nor to the fixation material. With the increasing use of synthetic materials for primary and recurrent hernia repair, the number of patients presenting with late mesh infections is likely to increase.     

Laparoscopic inguinal hernia repair

Background: Despite numerous attempts to improve the techniques used for hernia repair, current published series show that recurrence rates are as high as 5-20%. The complexity of inguinal anatomy, combined with multiple potential areas of weakness, has contributed to the difficulty in preventing recurrences. However, the laparoscopic approach to inguinal herniorrhaphy has allowed clear visualization of all preperitoneal fascial planes and anatomic landmarks, as well as the hernia defect(s) and the peritoneal reflection. In the course of our performance of a series of 1,224 laparoscopic inguinal hernia repairs, we have developed a total extraperitoneal approach that yields excellent results with a low initial recurrence rate. Herein we describe our experience. Methods: After our initial 300 transabdominal preperitoneal (TAPP) hernia repairs, which resulted in six recurrences, two bowel injuries, one bladder injury, and six cutaneous nerve injuries, the total extraperitoneal approach (TEP) was adopted. Results: The first 300 TEP repairs resulted in one recurrence, two bowel injuries, one bladder injury, and two cutaneous nerve injuries. All major complications occurred in patients who had had previous lower abdominal surgery. In the last 624 TEP herniorrhaphies we implemented some modifications to the technique, especially for patients with previous lower abdominal surgery. In this group we recorded one bladder injury, no cutaneous nerve injuries, and one recurrence. Conclusions: The total extraperitoneal approach for laparoscopic herniorrhaphy allows for a safe and effective repair with low rates of complication and recurrence. A thorough knowledge of the anatomy of the extraperitoneal space and especially the two- and three-dimensional inguinal anatomy of this space contributed greatly to the evolution of our technique.