Lichtenstein tension-free repair of inguinal hernia

Recurrences have been a significant problem following hernia repair. The purpose of this study was to present our experience of Lichtenstein tension-free repair of inguinal hernia. In this retrospective study, 223 inguinal hernia repairs were performed between September 2000 and August 2003 in 203 patients, using a polypropylene mesh. The main outcome measure was early and late complications and especially recurrences. There were 189 males (93.1%) and 14 females (6.9%). Inguinal hernia was indirect in 70% of cases (n=156), direct in 25% (n=56), and of the mixed type in 5% (n=11). Bilateral inguinal hernia was found in 20 patients (9.8%). 210 (94.2%) of hernias were de novo, while 13 (5.8%) were recurrences. The mean patients age was 54.3 years (range, 32-71 years). The follow-up was completed in 160 patients (78.8%) by clinical examination. The median follow-up period was 3.0 years (range, 1-5 years). Seroma and postoperative neuralgia were observed in one and 5 patients respectively. There was only one recurrence (0.4%) four years later. Lichtenstein tension-free mesh repair of inguinal hernia is a simple and safe method, with no significant early and late morbidity and achieved a method with no recurrence during the follow-up period.     

腹股沟疝无张力修补术后慢性疼痛的原因及治疗

目的 探讨无张力疝修补术后慢性疼痛的原因、预防对策及治疗.方法 回顾性分析我院2009年4月至20lO年5月106例腹股沟疝无张力修补术后患者的临床资料进行随访.结果 本组患者均行无张力疝修补术,随访时间3～13个月,术后出现3个月以上慢性疼痛不能缓解并需要进一步治疗的患者6例,发生率为5.66%.结论 局麻下熟练的手术操作、部分可吸收修补材料应用、腹膜外修补方式以及改良的补片固定方式可以减少腹股沟疝无张力修补术后慢性疼痛的发生.     

疝环充填式无张力修补术治疗腹股沟疝的体会

目的探讨疝环充填式无张力修补术在腹股沟疝中的应用。方法对我院2006年1月至2009年12月期间腹股沟疝施行疝环充填式无张力修补术的96例患者的临床资料进行回顾性分析。结果本组患者手术全部成功,随访6个月至4年,无复发病例。结论疝环充填式无张力修补术可以安全、有效地应用于腹股沟疝患者。     

无张力补片修补治疗腹股沟嵌顿疝的临床观察

目的探讨无张力疝修补术治疗腹股沟嵌顿疝的临床效果。方法回顾采用无张力补片修补治疗的患者50例（观察组）和应用传统手术方法治疗的患者42例,分析两者的手术一般情况、术后并发症和复发率。结果两组患者的手术时间比较,差异无统计学意义（P〉0．05）,但是观察组患者术后下床活动时间、术后疼痛时间和住院时间均短于对照组,存在统计学差异（P〈0．05）。观察组患者并发症发生率为12．00％,明显低于对照组的35．71％,差异具有统计学意义（P〈0．05）。两组患者术后均随访18～24个月．观察组患者复发l例,复发率为2．00％,对照组复发8例,复发率为19．05％;传统手术的复发率明显高于无张力补片修补治疗者,差异有统计学意义（P〈0．05）。结论无张力补片修补治疗腹股沟嵌顿疝具有手术痛苦小、术后恢复快、复发率低、安全可靠．值得临床推广应用。     

腹腔镜腹膜前与Lichtenstein腹股沟疝无张力修补术的对比研究

目的：研究3D补片在腹腔镜经腹腹膜前疝修补术（transabdominal preperitoneal,TAPP）中的疗效。方法：回顾分析2012年2月至2013年4月收治的100例腹股沟疝患者的临床资料,50例患者应用3D补片行腹腔镜TAPP（观察组）,50例应用聚丙烯平片行腹股沟疝无张力修补术（Lichtenstein,对照组）。对比两组术中、术后情况及住院总费用。结果：观察组术后疼痛指数较小,术后疼痛持续时间较短,术后可较早地下床活动,术后并发症发生率较低,两组相比差异均有统计学意义（P〈0.05）;但观察组住院总费用较高,差异有统计学意义（P〈0.05）;观察组手术时间相对较长,但差异无统计学意义（P〉0.05）。术后随访8个月,观察组与对照组复发率分别为2%与4%,两组复发率相比差异无统计学意义（P〉0.05）。结论：腹腔镜TAPP体现了微创理念,术后不良反应较少,对腹股沟疝修补的治疗效果值得肯定。3D补片与TAPP术式配合应用可达到更好的效果。     

腹股沟疝无张力修补术后补片感染的外科治疗

目的探讨腹股沟疝无张力修补术后,补片感染的临床治疗经验。 方法采用回顾性横断面研究方法,收集2012年5月至2018年1月四川大学华西医院收治的35例腹股沟疝无张力修补术后感染患者的临床资料。观察指标：（1）手术及术后情况包括术后并发症情况、术后住院时间、抗生素的选择和使用。（2）随访情况包括术后再感染和远期并发症情况。采用电话、门诊或住院方式对患者进行6个月的随访,了解患者术后再感染及远期并发症发生情况。随访时间截止至2018年7月。正态分布的计量资料采用 ±s表示。 结果（1）手术及术后情况：35例腹股沟疝无张力修补术后感染患者均接受补片取出术,术后均使用抗生素抗感染治疗及创面敞开引流或安置引流管负压引流,其中行局麻手术患者2例,行全麻手术患者33例。35例补片取出中有3例补片侵及肠管,其中2例行肠切除吻合,1例补片侵蚀肠管为阑尾,行阑尾切除术。平均术后住院时间为（6.72±3.43）d。（2）随访情况：术后随访6个月,随访期间患者无术后并发症发生。患者术后随访均无腹股沟疝复发。 结论对腹股沟疝无张力修补术后补片感染患者,行补片取出术安全可靠,在处理补片感染时应及时手术。     

个体化疼痛护理对局部麻醉腹股沟疝无张力修补术后疼痛的影响

目的探究评估个体化疼痛护理模式对腹股沟疝无张力修补术后患者疼痛的影响。 方法选择2020年6月至2021年6月临泉县人民医院接收的75例腹股沟疝行局部麻醉下腹股沟疝无张力修补术的患者,将其随机分为常规护理（38例）与个体化疼痛护理组（37例）。比较2组患者术后急性期疼痛情况,包括术后72 h内的初始疼痛评分和疼痛强度最高评分。 结果在72 h内,个体化疼痛护理组的疼痛强度评分显著低于常规护理组,包括初始运动和静息疼痛程度评分（P<0.05）,以及疼痛强度最高的运动和休息时的疼痛评分（P<0.05）。 结论个体化疼痛护理可以改善局部麻醉下腹股沟疝无张力修补术的术后急性期疼痛。     

Open tension-free Lichtenstein repair of inguinal hernia: use of fibrin glue versus sutures for mesh fixation

Purpose

To investigate pain and other complications following inguinal hernioplasty performed by the Lichtenstein technique with mesh fixation by fibrin glue or sutures.

Methods

Five hundred and twenty patients were enrolled in this 12-month observational multicenter study and received either sutures or fibrin glue (Tissucol^?/Tisseel^?) based on the preference of the surgeon. Pain, numbness, discomfort, recurrence, and other complications were assessed postoperatively and at 1, 3, 6, and 12?months. Pain intensity was assessed by a visual analog scale (VAS; 0 [no pain] to 10 [worst pain]).

Results

One hundred and seventy-one patients received sutures and 349 received fibrin glue. During the early postoperative phase, 87.4% of patients in the fibrin glue group and 76.6% of patients in the sutures group were complication-free (P?=?0.001). Patients who received fibrin glue were also less likely to experience hematoma/ecchymosis than those in the suture group (both P?=?0.001). The mean pain score was significantly lower in the fibrin group than the sutures group (2.5 vs. 3.2, P?<?0.001). At 1?month, significantly fewer patients in the fibrin glue group reported pain, numbness, and discomfort compared with patients in the sutures group (all P?<?0.05). Fibrin glue patients also experienced less intense pain (0.6 vs. 1.2; P?=?0.001). By 3?months, the between-group differences had disappeared, except for numbness, which was more prevalent in the sutures group. By 12?months, very few patients reported complications.

Conclusions

Tissucol fibrin glue for mesh fixation in the Lichtenstein repair of inguinal hernia shows advantages over sutures, including lower incidence of complications such as pain, numbness, and discomfort, and should be considered as a first-line option for mesh fixation in hernioplasty.     

疝环填充式和平片式无张力疝修补术治疗腹股沟疝疗效比较

目的:分析比较疝环填充式和平片式无张力疝修补术治疗腹股沟疝的临床疗效。方法:将2007年1月～2010年12月在我院普外科诊断患腹股沟疝的共327例住院患者,根据患者当时采用的手术方式分为疝环填充式和平片式无张力疝修补术。对比分析这2种腹股沟疝无张力修补术在平均手术时间、平均住院费用、术后并发症、复发率和术后疼痛等方面的差异。结果:所有患者手术均顺利,2种手术类型在平均手术时间、平均住院费用、术后疼痛发生率、术后阴囊血肿发生率方面比较,差异有统计学意(P〈0.05),术后复发率组间差异无统计学意义。结论:与疝环填充式无张力疝修补术相比,平片腹股沟疝无张力修补术技术难度小、易开展,术后疼痛轻、恢复快,且费用低,基层医院的大部分患者经济上能够承受,具有独特优势。     

UHS与Lichtenstein无张力疝修补术的对比研究

目的比较腹股沟疝应用UHS装置与Lichtenstein修补术式的优缺点。方法回顾性分析2010-12—2012-12间行UHS疝修补114例与Lichtenstein疝修补88例手术时间、术后住院天数、慢性疼痛、并发症等资料。结果 2种术式在住院时间、复发率等方面差异无统计学意义(P>0.05);Lichtenstein修补术手术时间明显短,手术费用低,但术后慢性疼痛评分较高。结论应用UHS装置与Lichtenstein无张力疝修补术均可以用于腹股沟疝修补,各有优缺点。     

Meta-analysis of Prolene Hernia System mesh versus Lichtenstein mesh in open inguinal hernia repair

BackgroundThis study was designed to systematically analyse all published randomized clinical trials comparing the Prolene Hernia System (PHS) mesh and Lichtenstein mesh for open inguinal hernia repair.MethodA literature search was performed using the Cochrane Colorectal Cancer Group Controlled Trials Register, the Cochrane Central Register of Controlled Trials in the Cochrane Library, MEDLINE, Embase and Science Citation Index Expanded. Randomized trials comparing the Lichtenstein Mesh repair (LMR) with the Prolene Hernia System were included. Statistical analysis was performed using Review Manager Version 5.1 software. The primary outcome measures were hernia recurrence and chronic pain after operation. Secondary outcome measures included surgical time, peri-operative complications, time to return to work, early and long-term postoperative complications.ResultsSix randomized clinical trials were identified as suitable, containing 1313 patients. There was no statistical difference between the two types of repair in operation time, time to return to work, incidence of chronic groin pain, hernia recurrence or long-term complications. The PHS group had a higher rate of peri-operative complications, compared to Lichtenstein mesh repair (risk ratio (RR) 0.71, 95% confidence interval 0.55–0.93, P = 0.01).ConclusionThe use of PHS mesh was associated with an increased risk of peri-operative complications compared to LMR. Both mesh repair techniques have comparable short- and long-term outcomes.     

自固定补片与缝合补片在Lichtenstein无张力疝修补术修复腹股沟疝的效果对比

目的探讨Lichtenstein无张力疝修补术中应用自固定补片与缝合补片修复腹股沟疝的效果和安全性。 方法选择2017年1月至2018年7月湖北省公安县人民医院收治的腹股沟疝患者112例,均行Lichtenstein无张力疝修补术。采取随机数字表法将患者分为观察组（自固定补片）和对照组（缝合补片）各56例。比较2组患者手术时间、住院费用、术后异物感、术后疼痛[视觉模拟评分法（VAS）]、术后并发症（阴囊积液、切口感染）、复发率等临床指标差异性,观察手术前后生活质量[生活质量综合评定问卷-74（GQOLI-74）]变化情况。 结果观察组患者手术时间短于对照组,住院费用高于对照组（P均<0.05）;观察组患者术后1、3、6、9、12个月的异物感发生率明显低于对照组,术后3 d和1、3、6、12个月的VAS评分均低于对照组（P均<0.05）;2组患者术后阴囊积液、切口感染发生率比较差异无统计学意义（P>0.05）,随访12个月均未出现复发病例;术后3个月,2组患者GQOLI-74各维度评分均较术前升高（P<0.05）,观察组患者躯体功能评分高于对照组（P<0.05）。 结论Lichtenstein无张力疝修补术中应用自固定补片与缝合补片修复腹股沟疝的并发症均较少且无复发情况,使用自固定补片可缩短手术时间,减轻术后疼痛和异物感,有利于改善生活质量,但其住院费用相对较高。     

腹股沟无张力疝修补个体化治疗体会

目的探讨腹股沟疝分型及相应手术方式，提高腹股沟疝治疗水平。方法总结2000年2月至2007年9月502例腹股沟疝个体化无张力修补术。结果随访3个月至7年，无张力个体化腹股沟疝修补者3例复发。结论根据患者疝类型及年龄和完善手术方法等具体情况施行个体化无张力疝修补，可最大限度减少腹股沟疝复发。     

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…     

疝环充填式无张力疝修补术在复发疝治疗中的体会

目的 探讨疝环充填式无张力疝修补术在腹股沟复发疝中的临床应用价值.方法 回顾性分析我院2005年1月至2011年8月腹股沟复发疝修补术65例临床资料,65例均采用疝环充填式无张力疝修补术,其中23例采用腹膜前修补术.结果 本组65例患者全部治愈,7~9 d出院,术后急性尿潴留7例,阴囊积液4例,慢性疼痛2例,术后2个月网塞感染1例.全部患者随访3个月至6年,无复发.结论 疝环充填式无张力疝修补术治疗腹股沟复发疝效果良好.     

Randomized clinical trial of lightweight composite mesh for Lichtenstein inguinal hernia repair

BACKGROUND: Almost half the patients who undergo hernia repair with mesh report a feeling of stiffness and a foreign body in the groin. This study evaluated whether patients noticed any difference between lightweight and standard polypropylene mesh for the repair of inguinal hernia. METHODS: Patients scheduled for elective repair of unilateral or bilateral, primary or recurrent inguinal hernia by the Lichtenstein technique were randomized to receive either a conventional densely woven polypropylene mesh (100-110 g/m(2)) or a lightweight composite multifilament mesh (polypropylene 27-30 g/m(2)). Quality of life was assessed using Short Form 36 before operation and 6 months after surgery. Pain was assessed by means of a visual analogue scale 2 days and 6 months after surgery. The primary outcome measure was the feeling of a foreign body in the groin at 6 months. RESULTS: Some 122 hernias were randomized; 117 were included in the analysis of perioperative data, and 106 were re-examined after 6 months. There were no differences between the treatment groups with respect to early and late surgical complications. Use of lightweight mesh was associated with significantly less pain on exercise after 6 months (P = 0.042). In addition, fewer patients reported the feeling of a foreign body after repair with lightweight mesh (17.2 versus 43.8 per cent with conventional mesh; P = 0.003). Quality of life was improved significantly at 6 months compared with the preoperative assessment, and there were no differences between the treatment groups. CONCLUSION: Lightweight polypropylene mesh may be preferable for Lichtenstein repair of inguinal hernia. Larger cohorts with longer follow-up are needed before it can be recommended for routine use.     

Lichtenstein术后复发性腹股沟疝的腔镜治疗

目的：评价腹腔镜下经腹腹膜前入路（TAPP）治疗Lichtenstein术后复发性腹股沟疝的临床效果。 方法：回顾性分析2009年5月—2014年3月间中南大学湘雅医院行腹腔镜下TAPP治疗的12例Lichtenstein术后复发疝患者临床资料。 结果：全组均顺利完成腹腔镜手术,无1例中转开放手术。平均手术时间为（110±25）min,术后2例发生血清肿,经穿刺抽液治愈。术后均于48 h内痊愈出院,随访至目前无1例再复发。 结论：腹腔镜下TAPP是治疗Lichtenstein术后复发性腹股沟疝安全有效的方法。

     

腹股沟疝无张力修补术712例术后并发症原因分析

目的探讨腹股沟疝无张力修补术后并发症的原因及处理方法。方法回顾分析2006年1月至2009年6月我科712例腹股沟疝无张力修补术患者的临床资料。结果有效随访676例,出现并发症57例(8.4%),其中复发4例(0.59%),腹股沟区不适及慢性疼痛18例(2.66%),切口脂肪液化感染5例(0.74%),阴囊积液积血16例(2.37%),膀胱损伤2例(0.30%),尿潴留11例(1.63%),缺血性睾丸炎1例(0.15%)。予以处理后均恢复良好。结论腹股沟疝术后并发症重点在于预防,疝外科医师应提高专业技能和选择合适的治疗方案以降低并发症的发生率。