Association between haematoma after inguinal hernia repair and site of heparin injection.

OBJECTIVE--To see if subcutaneous heparin prophylaxis against deep vein thrombosis and pulmonary embolism given into the abdominal wall caused more haematomas after repair of inguinal hernia than the same dose given into the shoulder. DESIGN--Random control trial. SETTING--District hospital. SUBJECTS--101 consecutive patients admitted for elective inguinal hernia repair. INTERVENTIONS--Four injections of sodium heparin 5,000 IU given either into the abdominal wall or the shoulder, the first two hours, before, and the last 24 hours after operation. MAIN OUTCOME MEASURE--Incidence of haematoma after operation. RESULTS--There was no significant difference in the incidence of haematoma between the groups. Haematoma formation was associated with a fall in systolic blood pressure of more than 25% (p = 0.055), which in turn was significantly associated with age over 60 years (p less than 0.0003). CONCLUSION--Injection of heparin subcutaneously into the abdominal wall does not lead to more wound haematomas than injection into the shoulder. Haematoma formation seems to be associated with a drop in systolic blood pressure of 25% or more, and thus requires further investigation.     

Subcutaneous heparin and postoperative wound hematomas. A prospective, double-blind, randomized study

A prospective, double-blind, controlled study was conducted to assess the incidence of postoperative wound hematomas associated with low-dose subcutaneous heparin therapy among patients undergoing surgery for a single inguinal hernia. The groups were well matched. The results indicate that low-dose heparin therapy is associated with more wound hematomas. Complications of low-dose heparin therapy and new ways to avoid these complications are discussed. The indications for the prophylactic administration of low-dose heparin therapy need careful assessment.     

Low-dose heparin prophylaxis and postoperative wound hematoma

In a randomized study, 124 patients, undergoing abdominal hysterectomy, were examined for postoperative wound hematoma after receiving low-dose heparin or heparin-dihydroergotamin (DHE) prophylaxis. Different sites of injection were chosen, with or without subcutaneous administration of thrombin at the end of surgery. The postoperative incidence of wound hematoma was not improved by subcutaneous thrombin administration. There was no difference between the two types of prophylaxis. When heparin or heparin/DHE was injected in the upper arm, however, fewer hematomas were found than after injection in the abdominal region. Investigations of the coagulation and fibrinolytic systems showed no difference between the two types of prophylaxis and injection site. The administration of thrombin did not cause intravascular activation of the coagulation system.     

Systematic review and meta-analysis of the effectiveness of antibiotic prophylaxis in prevention of wound infection after mesh repair of abdominal wall hernia

BACKGROUND: The aim was to determine whether systemic antibiotic prophylaxis prevented wound infection after repair of abdominal wall hernia with mesh. METHODS: This was a systematic review of the available literature identified from multiple databases using the terms 'hernia' and 'antibiotic prophylaxis'. Randomized placebo-controlled trials of antibiotic prophylaxis in abdominal wall mesh hernia repair with explicitly defined wound infection criteria and a minimum follow-up of 1 month were included. After independent quality assessment and data extraction, data were pooled for meta-analysis using a random-effects model. RESULTS: The search process identified eight relevant trials. Two papers on umbilical, incisional or laparoscopic hernias, and six concerning inguinal and femoral (groin) hernias were suitable for meta-analysis. The incidence of infection after groin hernia repair was 38 (3.0 per cent) of 1277 in the placebo group and 18 (1.5 per cent) of 1230 in the antibiotic group. Antibiotic prophylaxis did not significantly reduce the incidence of infection: odds ratio 0.54 (95 per cent confidence interval 0.24 to 1.21); number needed to treat was 74. The number of deep infections was six (0.6 per cent) in the placebo group and three (0.3 per cent) in the antibiotic prophylaxis group: odds ratio 0.50 (95 per cent c.i. 0.12 to 2.09). CONCLUSION: Antibiotic prophylaxis did not prevent the occurrence of wound infection after groin hernia surgery. More trials are needed for complete evidence in other areas of abdominal wall hernia.     

腹股沟疝日间手术患者护理模式的探讨与分析

目的探讨与分析日间手术治疗腹股沟疝患者的护理模式。 方法回顾性分析2017年1月至2019年1月,首都医科大学附属北京朝阳医院疝和腹壁外科就诊的3266例腹股沟疝日间手术患者。其中,儿童疝患者1111例（34.0%）,成人疝患者根据手术方式不同分为开放组和腹腔镜组。开放组患者1256例（38.46%）,腹腔镜组患者例899（27.54%）,记录全部患者围手术期护理的并发症与相应的处理对策。 结果所有患者手术过程顺利,儿童疝组围手术期出现尿浸湿伤口敷料24例（2.2%）,活动后出现伤口敷料脱落13例（1.2%）,急性疼痛21例（1.9%）;成人疝组围手术期出现排尿困难48例（2.2%）,急性疼痛69例（3.2%）,发热33例（1.5%）,体位性低血压12例（0.6%）,恶心呕吐20例（0.9%）;所有成人组患者围手术期出现特殊事件5例（0.2%）,术后转普通病房7例（0.3%）,夜间再次急诊就诊11例（0.5%）。所有患者随访期间均未出现伤口感染、液化等并发症。 结论在日间手术治疗腹股沟疝患者的围手术期中,良好的腹股沟疝日间手术护理模式,以及定期密切的随访,能显著提升临床治疗效率,有助于减少患者围手术期并发症的发生及早日康复。     

Antibiotic prophylaxis in patients undergoing open mesh repair of inguinal hernia: a meta-analysis

The use of antibiotic prophylaxis in hernia repair is still under debate. The aim of this meta-analysis was to assess the effect of antibiotic prophylaxis in patients undergoing open mesh repair of inguinal hernia with respect to incidence of postoperative surgical site infection (SSI). A literature search was conducted in databases of MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials. Study selection, data extraction, quality assessment, and meta-analysis were conducted according to the recommendations by Cochrane collaboration. Nine randomized controlled trials were included. Incidence of surgical site infection was 39/1642 (2.38%) in the antibiotic group and 70/1676 (4.18%) in the control group. Antibiotics showed a protective effect in preventing SSI after mesh inguinal hernia repair (odds ratio: 0.61, 95% confidence interval: 0.40-0.92, I(2): 0%). Antibiotic prophylaxis did reduce the incidence of SSI in hernia patients undergoing mesh hernioplasty. The cost effectiveness of antibiotic prophylaxis needs further evaluation.     

The role of antibiotic prophylaxis in prevention of wound infection after Lichtenstein open mesh repair of primary inguinal hernia: a multicenter double-blind randomized controlled trial

OBJECTIVE: To determine whether the use of prophylactic antibiotics is effective in the prevention of postoperative wound infection after Lichtenstein open mesh inguinal hernia repair. SUMMARY BACKGROUND DATA: A recent Cochrane meta-analysis (2003) concluded that "antibiotic prophylaxis for elective inguinal hernia repair cannot be firmly recommended or discarded." METHODS: Patients with a primary inguinal hernia scheduled for Lichtenstein repair were randomized to a preoperative single dose of 1.5 g intravenous cephalosporin or a placebo. Patients with recurrent hernias, immunosuppressive diseases, or allergies for the given antibiotic were excluded. Infection was defined using the Centers for Disease Control and Prevention criteria. RESULTS: We included 1040 patients in the study between November 1998 and May 2003. According to the intention-to-treat principle, 1008 patients were analyzed. There were 8 infections (1.6%) in the antibiotic prophylaxis group and 9 (1.8%) in the placebo group (P = 0.82). There was 1 deep infection in the antibiotic prophylaxis group and 2 in the placebo group (P = 0.57). Statistical analysis showed an absolute risk reduction of 0.19% (95% confidence interval, -1.78%-1.40%) and a number needed to treat of 520 for the total number of infections. For deep infection, the absolute risk reduction is 0.20% (95% confidence interval, -0.87%-0.48%) with a number needed to treat of 508. CONCLUSIONS: A low percentage (1.7%) of wound infection after Lichtenstein open mesh inguinal (primary) hernia repair was found, and there was no difference between the antibiotic prophylaxis or placebo group. The results show that, in Lichtenstein inguinal primary hernia repair, antibiotic prophylaxis is not indicated in low-risk patients.     

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??Application of biologic mesh in the treatment of inguinal hernia SUN Li, CHEN Jie, SHEN Ying-mo, et al. Department of Hernia and Abdominal Wall Surgery, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100043, China
Corresponding author: CHEN Jie, E-mail: chenjiejoe@sina.com
Abstract Biologic mesh is the landmark of the repair material in the field of the hernia and abdominal wall surgery. In contrast with the traditional polypropylene materials, the advantages of biologic mesh are richly endowed by nature. It has been used in inguinal hernia, umbilical hernia, incisional hernia, stoma hernia, esophageal hiatal hernia, hernia of pelvic floor, and the reconstruction of the abdominal wall tumor, infection or trauma. Biologic mesh is applied early in the aspect of inguinal hernia repair. It has obvious advantages in repair of adolescent inguinal hernia, preventing or reducing postoperative spermatic cord adhesion and ejaculation pain in male patients, and repair of abdominal wall hernia with contaminated or potential contaminated wound. Seroma/hematoma and fever are the most common complications associated with the biologic mesh, and the incidence rate is several times of the synthetic ones. In addition, the biologicmesh is much more expensive and has a higher cost of use, which has become an important factor in limiting its application. In general, it is difficult to be the perfect substitute of traditional artificial synthetic mesh currently.     

Hernia repair in elderly patients

Background This study evaluates a 5-year experience of the management of the most frequent abdominal wall hernias in an elderly population. Methods From April 1990 to December 1995, 231 inguinal, 12 femoral and seven umbilical hernias were repaired in 221 patients (mean age 74 (range 66–93) years). Concomitant diseases were present in 157 patients, A mesh repair was performed with ‘tension-free’ or ‘plug’ techniques in all but 23 inguinal and two femora! hernia repairs, in which the Bassini or Shouldice procedures were adopted. Ten emergency hernia repairs were performed for strangulation. A total of 232 operations, including four emergency hernia repairs, were carried out under local anaesthesia. Results There was no perioperative mortality. Acute intestinal bleeding occurred 2 days after surgery in a patient with colonic diverticular disease. Urinary retention occurred once following emergency hernia repair under general anaesthesia and twice after elective hernia repair under local anaesthesia. Local complications included four scrotl haematomas (2 per cent), three wound infections (1 per cent) and one case of orchitis with atrophy after repair of a recurrent hernia. There was one recurrence after a Bassini repair and one after Shouldice inguinal herniorrhaphy. No recurrence was observed after mesh repair. Conclusion Local anaesthetic mesh hernia repair is safe and effective in elderly patients. Age should be no bar to elective hernia repair. This policy should avoid the complications of emergency operation.     

腹股沟斜疝平片式无张力修补术60例体会

目的 探讨腹股沟斜疝用腹股沟管后壁修补对防止疝复发等并发症的作用.方法 采集我院2009年5月至2010年5月收治的腹股沟斜疝患者60例,均行平片式无张力修补,观察患者术中、术后并发症及复发率.结果 60例患者切口愈合良好,随访1年未复发;手术时间为31～76 min,住院天数5～14 d,所有患者术后1～5 d均出现不同程度伤口疼痛,除1例予以镇痛治疗外,其他均未做任何处理.结论 腹股沟斜疝行腹股沟管后壁修复构成完整腹股沟管后壁手术操作简单,能有效减轻术后疼痛、异物感、预防疝复发等其他并发症.     

Porcine dermal collagen (Permacol) for abdominal wall reconstruction

OBJECTIVE: A review of Eisenhower Army Medical Center's experience using Permacol (Tissue Science Laboratories, Covington, Georgia) for the repair of abdominal wall defects. METHODS: Retrospective review of medical records of patients undergoing abdominal wall reconstruction with Permacol. RESULTS: From July 30, 2003 to February 12, 2005, 9 patients underwent repair of complicated fascial defects with Permacol. Indications for surgery included reoperative incisional hernia repair after removal of a infected mesh (3 patients), reconstruction of a fascial defect after resection of an abdominal wall tumor (2 patients), incisional hernia repair in a patient with a previous abdominal wall infection after a primary incisional hernia repair (1 patient), incisional hernia repair in a patient with an ostomy and an open midline wound (1 patient), emergent repair of incisional hernia with strangulated bowel and multiple intra-abdominal abscesses (1 patient), and excision of infected mesh and drainage of intra-abdominal abscess with synchronous repair of the abdominal wall defect (1 patient). At a median follow-up of 18.2 months, 1 recurrent hernia existed after intentional removal of the Permacol. This patient developed an abdominal wall abscess 7 months after hernia repair secondary to erosion from a suture. Overall, 1 patient developed exposure of the Permacol after a skin dehiscence. The wound was treated with local wound care, and the Permacol was salvaged. Despite the presence of contamination (wound classification II, III, or IV) in 5 of 9 patients (56%), no infectious complications occurred. CONCLUSION: Complex reconstruction of the abdominal wall can be associated with a high complication rate. Placement of a permanent prosthetic mesh in a contaminated field is associated with a high rate of wound infections and subsequent mesh removal. Permacol becomes incorporated by tissue ingrowth and neovascularization. Permacol is a safe and acceptable alternative to prosthetic mesh in the repair of complicated abdominal wall defects.     

腹腔镜腹股沟疝修补术后应用弹力裤预防并发症的疗效观察

目的 探讨腹腔镜腹股沟疝修补术后应用弹力裤预防术后并发症的效果。方法 回顾性分析2012年10月至2013年12月,山东省聊城市人民医院收治的腹股沟疝患者50例,均采用腹腔镜腹股沟疝修补术。术后将患者随机分为实验组和对照组,每组各25例。实验组在常规护理基础上应用弹力裤1周。对照组术后应用阴囊托抬高阴囊,沙袋压迫患侧腹股沟区。观察二组患者术后切口疼痛程度、阴囊肿胀情况等。结果 实验组腹股沟疝患者在手术后12、24、48h的疼痛程评分与对照组比较差异均有统计学意义（t=5．102、8．294、7．745,P=0．026、0．017、0．019）。二组患者术后12、24、48h阴囊肿胀发生率比较差异有统计学意义（X^2=27．29、30．13、25．65,P=0．030、0．021、0．034）。结论 腹腔镜腹股沟疝修补术后应用弹力裤可预防或减少术后并发症的发生。     

Combined transurethral prostatectomy and inguinal hernia repair: a retrospective audit and literature review.

OBJECTIVE: To audit the results of combined transurethral resection of the prostate (TURP) and inguinal hernia repair, often carried out under the same anaesthetic (because bladder outlet obstruction from prostatic disease and inguinal hernia are both common conditions in elderly men), to avoid two separate operations. PATIENTS AND METHODS: The study included 85 patients who underwent primary inguinal hernia repair with TURP in the urology unit of Nottingham City hospital between 1989 and 1995, and who were recalled to a special clinic. The type of hernia and repair carried out were recorded and complications audited with specific reference to recurrence of hernia and wound infection. RESULTS: The 85 patients underwent 88 primary inguinal hernia repairs with TURP (three were bilateral). Maloney's darn repair was used on 55 and a Bassini repair on 33 occasions, respectively. Two patients developed mild wound infection after surgery, but only two patients (2%) had recurrence of hernia. CONCLUSIONS: The recurrence rate after primary inguinal herniorraphy with conventional methods of repair, performed with TURP, was comparable with published results of hernia repairs alone, before the introduction of Lichtenstein's mesh repair.     

Serious complication after subcutaneous injection of heparin for prophylaxis of thromboembolism. Case report

Subcutaneous application of low-dose heparin before and after surgery is a routine procedure to avoid thromboembolic complications. Advances in development of anticoagulants, reduction of intervals between applications, modern injection tools,and training of the personnel have already reduced the incidence of severe complications. However, the case presented shows impressively that a life-threatening complication is still possible and has to be kept in mind in perioperative thrombosis prophylaxis. After postoperative subcutaneous injection of low-dose-heparin in the right lower abdominal wall, a 76-year-old female patient suffered from an extensive,hemodynamically active hematoma located in the M.rectus abdominis as a sequela of perforating the A. epigastrica superficialis.Consequently hypovolemic shock led to cardiopulmonary circulatory arrest.After immediate resuscitation, surgical hemostasis was performed and the hematoma was removed. Post-interventional stabilization of circulation and wound healing were trouble free.     

The safety and efficacy of prosthetic hernia repair in clean-contaminated and contaminated wounds

Prosthetic mesh reinforcement of abdominal wall hernias has gained acceptance as a result of its ease of placement and a favorably low incidence of hernia recurrence. However, its use in contaminated wounds secondary to open bowel exposure is felt to be contraindicated because of potential septic complications and lack of incorporation. The impact of permanent mesh placement in contaminated fields on wound morbidity, hernia recurrence, and mortality was examined. Records of 24 consecutive patients having permanent mesh placement in contaminated wounds for repair of abdominal wall hernias between 1994 and 2001 were reviewed. Factors examined included age, hernia type, body mass index, comorbidity, degree of contamination, concurrent gastrointestinal procedures, wound morbidity, and mortality. The mean age and body mass index were 63 years and 26.1 kg/m2 respectively. Twelve patients had risk factors for wound complications or were immunocompromised. There were 11 incisional, eight parastomal, two femoral, and two inguinal repairs and one obturator hernia repair. Twenty-three were repaired with polypropylene and one with Gore-Tex mesh. Prosthetic herniorrhaphy was performed in nine patients with ostomies already in place and in 15 patients with concomitant bowel resections. Of those with bowel resections five had enterocutaneous fistulae, three had bowel resection because of injury during mobilization, six had resections for necrotic bowel, and one had enterostomy closure. Fourteen cases were clean contaminated and ten contaminated. Eight cases were performed under emergency conditions. Wound-related morbidity occurred in five patients (21%) and in all but one was limited to cellulitis and minor wound infections. Three patients died, but in all cases death was unrelated to the surgical procedure. No patient required mesh removal. One patient had a recurrent hernia after parastomal repair. Placement of permanent mesh prostheses in clean-contaminated and contaminated operative fields can be performed with minimal wound-related morbidity and patient mortality. Utilization of permanent mesh in these wounds is associated with a low incidence of hernia recurrence and eliminates the need for further surgery.     

A randomized, double-blind, placebo-controlled trial to determine effectiveness of antibiotic prophylaxis for tension-free mesh herniorrhaphy

BACKGROUND: In recent years, use of prosthetic material for inguinal hernia repair has increased dramatically. Tension-free repairs have gained popularity not only for recurrent or complicated hernias, but for primary hernia repairs as well. Although routine use of prophylactic antibiotics is not recommended in the Philippines for open nonimplant herniorrhaphy, there is little direct clinical evidence on which to base recommendations when implantable mesh is used. STUDY DESIGN: We conducted a prospective, randomized, double-blind, placebo-controlled trial comparing wound infection rates in 360 patients (180 received prophylactic antibiotics, 180 received a placebo) undergoing primary inguinal hernia repair electively using polypropylene mesh. Age, gender, American Society of Anesthesiologists class, type of hernia, type of anesthesia, and duration of operation were recorded. Infections were evaluated 1 week, 2 weeks, and 1 month after operation by an independent surgeon. All complications were recorded. Results were assessed using chi-square, Fisher's exact test, and Student's t-tests as appropriate. RESULTS: Groups were well matched for all preoperative variables studied, including comorbid conditions. Six patients from the antibiotic group and four from the placebo group failed to followup after the second week. Superficial surgical site infection developed in 3 patients (1.7%) from the antibiotic group and 6 (3.3%) from the placebo group (p = 0.50). One from each group developed deep surgical site infection. Both patients were readmitted and underwent repeated debridement, which eventually resulted in graft loss. CONCLUSIONS: Preoperative administration of single-dose antibiotic for tension-free inguinal mesh herniorrhaphy did not markedly decrease risk of wound infection in this patient population. Our results do not support use of antibiotic prophylaxis for tension-free mesh herniorrhaphy.     

腹腔镜下经腹腹膜前疝无张力修补术治疗隐匿性疝的临床研究

目的 探讨腹腔镜下经腹腹膜前疝无张力修补术治疗隐匿性腹股沟疝的临床疗效,减少单侧腹股沟疝术后对侧假性复发的发生率.方法 回顾性分析南昌大学第二附属医院胃肠外科2017年1 月至2019年7月收治的单侧腹股沟疝行手术治疗的2 155 例病人,其中1 105 例病人行开放性疝修补术,927例病人行腹腔镜经腹腹膜前疝修补术(...     

Preincisional intraparietal Augmentin in abdominal operations.

A total of 624 consecutive eligible patients undergoing abdominal operations received a single preoperative dose of amoxycillin/clavulanic acid (1.2 g Augmentin) for the prophylaxis of surgical wound infection. They were randomised to have the antibiotic injected intravenously at induction of anaesthesia (n = 328) or infiltrated subcutaneously along the line of the proposed incision (n = 296). The incidence of wound infections was considerably lower in the group given the antibiotic into the abdominal wall (8.4% compared with 15.9%--chi 2 = 7.90, P = 0.005). No significant differences were found in the incidence of other major or minor infective or non-infective postoperative complications between the groups. It is concluded that preincisional intraparietal injection is more effective than intravenous injection of Augmentin for the prophylaxis of surgical wound infection.     

The role of antibiotic prophylaxis on wound infection after mesh hernia repair under local anesthesia on an ambulatory basis

Mesh prosthesis, local anesthesia, and ambulatory care have been widely introduced in recent decades in the treatment of inguinal hernia. The use of antibiotic prophylaxis during open inguinal hernia repair has been controversial. No prospective trial has been conducted to assess the role of antibiotic prophylaxis in patients operated on for inguinal hernia under the above-mentioned conditions. A prospective, randomized, double-blinded trial was initiated to assess the efficacy of antibiotic prophylaxis in the prevention of wound infection during open mesh inguinal hernia repair under local anesthesia on an ambulatory basis. Ninety-nine consecutive hernia repairs were randomized to receive 1 g of parenteral Cefazolin preoperatively or a placebo. No wound infections existed in the therapeutic group (0/50). Four infections appeared in the control group (4/49), and the study was suspended for ethical reasons when differences reached values close to statistical significance (P=0.059). We conclude that a single dose of intravenous Cefazolin decreases the risk of wound infection during open mesh inguinal hernia repair under local anesthesia on an ambulatory basis.