Repair of large midline incisional hernias with polypropylene mesh: Comparison of three operative techniques

Polypropylene mesh is widely used for the reconstruction of incisional hernias that cannot be closed primarily. Several techniques have been advocated to implant the mesh. The objective of this study was to evaluate, retrospectively, early and late results of three different techniques, onlay, inlay, and underlay. The records of 53 consecutive patients with a large midline incisional hernia — 25 women and 28 men, mean age 60.4 (range 28–94) — were reviewed. Polypropylene mesh was implanted using the onlay technique in 13 patients, inlay in 23 patients, and underlay in 17 patients. Either the greater omentum or a polyglactin mesh was interponated between the mesh and the viscera. The records of these 53 patients were reviewed with respect to: size and cause of the hernia, pre- and postoperative mortality and morbidity, with special attention to wound complications. Patients were invited to attend the outpatient clinic at least 12 months after implantation of the mesh for physical examination of the abdominal wall. Postoperative complications occurred in 14 (26.4%) patients. The onlay technique had significantly more complications, as compared to both other techniques. Reherniation occurred in 15 (28.3%) patients. The reherniation rate of the inlay technique was significantly higher than after the underlay technique (44% vs 12%, P=0.03) and tended to be higher than the onlay technique (44% vs 23%, P=0.22). Repair of large midline incisional hernias with the use of a polypropylene mesh carries a high risk of complications and has a high reherniation rate. The underlay technique seems to be the better technique.     

Shouldice 法和疝环充填式无张力修补术的疗效分析

目的：探讨疝环充填式疝修补术和shouldice术在腹股沟疝中的疗效对比和优缺点。方法：回顾性分析1998年8月至2002年2月间施行的35例疝环充填式无张力修补术和32例shouldice术的临床资料。结果：两组比较，从平均手术时间、术后下床活动时间、术后并发症和平均恢复正常活动时间均有显著性差异(P＜0．05)，随访24—70个月；平均38个月，术后复发率分别为0％和6．25％(P＞0．05)。结论：在无张力疝修补术中，疝环充填式无张力疝修补术疗效优于shouldice术。手术的近期疗效满意，远期疗效有待进一步观察。     

A new preperitoneal repair for inguinal hernia using a transpositioned external oblique aponeurotic flap

This study consists of a preliminary report of 94 cases with various types of inguinal hernias. All cases were repaired by a new technique, in which the herniotomy is performed via a preperitoneal approach and the repair is achieved by using a bipedicled flap from the external oblique aponeurosis, which is transpositioned into the preperitoneal space and sutured to the iliopubic tract. The details of this technique are herein described. After a follow-up ranging from 15 to 48 months, both the early and late complications are presented. They were minimal and of minor significance, apart from a hernial recurrence in one case.     

无张力疝修补术后顽固性疼痛原因和对策

目的 探讨无张力疝修补术后的顽固性疼痛病因及预防治疗。方法 将同期无张力疝修补术与传统的腹股沟疝修补方法进行比较。结果 无张力疝修补术后的顽固性疼痛率为9．02％(12／133)，传统的腹股沟疝修补方法疼痛率为8．61％(18／209)。无张力疝修补与传统的腹股沟疝修补相比，术后顽固性疼痛的发生率差异无显著性(P＞0．05)。结论 无张力疝修补并不一定减少传统的腹股沟疝修补术后顽固性疼痛，手术规范操作是预防的关键，治疗应先保守治疗，无效再考虑手术治疗。     

Obturator hernias — Report of seven cases

Summary Obturator hernias comprise a rare group of abdominal hernias. They are often diagnosed when the small bowel has become obstructed and the patients are operated on without the causes of the obstruction being known. Although many techniques for closure of the defect are available, there is no agreement at the present time as to which is the procedure of choice.     

影响急性外份性硬脑膜外血肿疗效的相关因素分析（附484例报告）

目的探讨影响急性外伤性硬脑膜外血肿疗效的相关因素。方法对1994年5月至2004年5月收治的484例外伤性硬脑膜外血肿患者的临床资料进行回顾性分析。结果无脑疝症状者手术死亡率7.7%,有脑疝症状者死亡率21.3%。手术距脑疝发生时间<1h死亡率8.2%,1～2h死亡率40.0%,>2h死亡率72.2%。结论影响外伤性硬脑膜外血肿疗效的相关因素较多,除脑疝形成及手术距脑疝发生的时间外,创伤性低血压、合并脑损伤的程度、呼吸功能不全、大面积脑梗塞、血糖与血浆渗透压升高及肝功能异常等均对患者预后有重要影响。     

Parapubic hernia: case report and review of the literature

Parapubic hernia is considered rare, with 18 hernias described in five articles published since 1971. The hernia results from iatrogenically or traumatically detached rectus abdominis muscles at the pubic bone and presents a therapeutic challenge because there is no strong aponeurotic anchoring structure in the defect's caudal aspect. We describe a patient with a large parapubic hernia repaired by a combined preperitoneal and onlay prosthetic method. This report adds another dimension to the prosthetic repair options in parapubic hernias and illustrates the effectiveness of the tension-free repair principle in their definitive management. Electronic Publication     

高频超声在小儿腹股沟斜疝手术治疗中的价值

目的　探讨高频超声检测小儿腹股沟斜疝腹股沟管扩张程度对于选择手术方式的价值。　方法　回顾分析 4 88例施行单纯疝囊高位结扎手术的小儿腹股沟斜疝超声检测的腹股沟管扩张最大内径 ,分组追踪其术后斜疝复发率。　结果　腹股沟管扩张最大内径 >1.5 cm的一组病例术后复发率明显增高。　结论　高频超声检测腹股沟管扩张最大内径 >1.5 cm的小儿腹股沟斜疝有必要行斜疝修补术 ,减少复发率 ,为临床医师提供有价值的客观指标     

Femoral pseudo-hernias

Before surgical intervention in the femoral area, doctors should be mindful of two situations in which surgery is not indicated and, in fact, may cause harm. Electronic Publication     

Laparoscopic repair of a diaphragmatic hernia through the foramen of Morgagni

A 78-year-old woman is described who presented with a diaphragmatic hernia through the foramen of Morgagni. A definitive diagnosis was confirmed by a sagittal view on magnetic resonance imaging prior to surgery. The hernia was repaired laparoscopically under an abdominal wall lifting technique without pneumoperitoneum, and her symptoms completely resolved postoperatively with no evidence of recurrence. The laparoscopic repair was considered a suitable and safe procedure for the treatment of a Morgagni hernia. Received: 3 April 1996/Accepted: 3 May 1996