Inguinal hernia repair in Hospital Authority hospitals: The role of laparoscopic hernioplasty

Objective: Two major changes have occurred in inguinal hernia repair during the last two decades: (i) the use of tension‐free mesh repair; and (ii) the application of laparoscopic technique for repair. The aims of the present study were to study: (i) how inguinal hernia repair was carried out; and (ii) the outcome of inguinal hernia repair in Hospital Authority (HA) hospitals. Methodology: This was a retrospective analysis on 8311 elective inguinal hernia repairs performed in 16 HA hospitals from January 2001 to December 2003. The mean age was 63.9 ± 14.2 years, and the male to female ratio was 22.0 : 1.0. Among these, 869 (10.5%) repairs were performed with the laparoscopic approach and 7442 (89.5%) repairs with the open approach. The proportion of laparoscopic hernia repair increased from 8.7% to 12.6%. Results: For open repair, 39% of cases were carried out with regional anaesthesia, 32% with general anaesthesia and 29% with local anaesthesia (LA). Furthermore, mesh repair was used in 88% of the patients. For laparosocpic repair, 98.4% of cases were carried out under general anaesthesia, and all patients had mesh repair using the totally extraperitoneal approach. A significantly higher proportion of bilateral repair and recurrent hernia repair was performed with the laparoscopic approach (P = 0.000). For primary unilateral repair, there was no significant difference in the postoperative length of stay (LOS) and the total LOS between the laparoscopic and the open surgery groups. No difference in LOS was found in recurrent hernia repair between the two groups. With respect to bilateral repair, both the preoperative LOS (P = 0.036) and total LOS (P = 0.039) were shorter in the laparoscopic group. Furthermore, a significantly higher proportion of day‐surgery patients was observed in the laparoscopic group than the open surgery group (21.3%vs 16.9%, P = 0.001). Nevertheless, when only the results of 2003 were analyzed, the postoperative LOS (P = 0.000) and total LOS (P = 0.000) were significantly shorter in the laparoscopic group than the open surgery group. The LOS parameters were significantly shorter in the open surgery LA subgroup compared with the non‐LA subgroup (P = 0.000), and they were not different from those in the laparoscopic group. Conclusions: The open mesh repair is the predominant approach for inguinal hernia repair in HA hospitals. The originally described local anaesthetic approach was under utilized, although it resulted in good outcome. The use of laparoscopic hernia repair is increasing and a learning curve was recently observed with improved outcome.     

改进后的腹腔镜腹腔内补片术在疝修补中的应用(附316例临床分析)

目的 腹腔镜腹腔内补片植入术(IPOM)，因有补片引起腹内组织粘连引发肠梗阻甚至复发等报道，目前争议较多，未能推广应用。作者改进了以上方法的多个步骤以克服该方法的不足。探讨改进后的方法在成人疝修补中的应用价值。方法 以缝合小儿疝的方法关闭内环口；把补片的中心固定在疝环口的中心：经腹壁用可吸收线代替钉合枪以针织的方法把补片四周牢牢地固定并展平紧贴在腹膜上。利用脐内侧韧带腹膜覆盖网片的内侧：减少网片外露的面积，减少粘连发生。结果 具有容易与腹膜相融合特性的网片能很快地与腹膜融合成一柔韧性组织，加强了疝环薄弱区，极少引起腹内肠管的粘连，更没有肠梗阻的发生，复发率低。结论 作者认为经过改进后的IPOM方法是一种效果确切、创伤少、并发症少、费用低、有微创优点。值得继续探索应用。     

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。     

无张力阴道吊带术治疗女性压力性尿失禁(附20例报告)

目的 评价无张力阴道吊带术(tension-free vaginal tape，TVT)治疗女性压力性尿失禁的疗效。方法 总结采用TVT术治疗女性压力性尿失禁20例的临床资料。结果 平均手术时间26.5min。拔除尿管后，19例病人控尿满意，1例仍有轻微尿失禁。术后平均随访12(3-24)个月，20例病人均无尿失禁。合并症有1例膀胱穿孔，1例术后轻度排尿不畅，2例尿频尿急。结论 TVT术操作简便快捷，创伤小，合并症少，术后康复快，是一种治疗女性压力性尿失禁的理想方法。     

Results of the tension-free vaginal tape procedure for stress incontinence: Patient''s perspective

BACKGROUND: To evaluate the results of the tension-free vaginal tape procedure (TVT) from a patient's perspective. METHODS: Between May 1999 and January 2002, 90 patients underwent a TVT for genuine stress incontinence (GSI) and mixed incontinence. Prior to the procedure, GSI was confirmed by clinical examination and urodynamic studies. Results were then audited from patient notes and the same patients were sent questionnaires to examine results from a patient perspective. RESULTS: Overall response rate to the questionnaire was 70 (77%). The mean age of the patients was 50.4 years (range 31-83 years). Sixty-one patients had spinal anesthesia, seven had general anesthesia and two had local anesthesia. Mean hospital stay was 3.36 days (range 2-14 days) and mean period from the operation to the time of the survey and audit was 16.34 months (range 3-28; SD 6.92). Thirty-nine (56%) of the 70 patients who answered said that the operation had cured their incontinence, 16 (23%) had an improvement in their symptoms, 7 (10%) had worsening of their symptoms and 8 (11%) felt that the operation did not make any difference. The overall success rate according to the patients' perspective was 79%, whereas our audit showed an overall success rate of 86% (77% and 82%, respectively, when we compared only the 66 patients who had both notes and replies available for analysis). CONCLUSION: Although a patient's perception regarding the success of TVT tends to differ from that of a clinician, it was not found to be statistically significant (P = 0.22, McNemar test). The TVT is a very successful operation, but realistic cure rates should be offered to patients.     

Long-term result and current status of the Lichtenstein open tension-free hernioplasty

Summary The tension-free hernioplasty project began in 1984 at the Lichtenstein Hernia Institute. The method consists of complete reinforcement of the inguinal floor with a large sheet of mesh, with adequate mesh tissue interface beyond the boundary of the inguinal floor and creation of a new internal ring made of prosthesis. The preliminary report of this operation was published in 1989, with no recurrence at that point in time. Shortly after the submission of the report, several recurrences were encountered. Based on the lesson learned from those recurrences, the operation was slightly modified and reported in 1991 [Amid 1993]. Since then, the Lichtenstein technique has gained world-wide popularity. Outcome measures identical to ours and other authors have been achieved by even those surgeons who have no special interest or expertise in herniology. The purpose of this article is to report the current state of the open tension-free hernioplasty for the repair of primary and recurrent inguinal hernias.     

老年腹股沟疝患者疝环充填式无张力修补术86例

目的总结弛环充填式无张力修补术治疗老年腹股沟疝患者的经验。方法回顾分析2002年3月-2005年7月采用德国Braun公司生产的Braun mesh和plug治疗的86例老年腹股沟疝患者的临床资料。结果平均手术时间35min，术后8-10h下床活动，2周恢复日常生活，伤口均一期愈合，术后尿潴留15例，异物感3例，随访3—40个月无一例复发。结论疝环充填式无张力修补术操作方便，创伤小，恢复快，复发率低，是老年患者理想有效的疝修补术。     

Structure and Concentration Capacity of the Kidneys in Brattleboro Rats under Conditions of Long-Term Vasopressin Treatment

Endoprostheses made from knitted fabric of 3 loop types were used for hernioplasty in rats. Biocompatibility of implanted textile constructions was evaluated after 6 months. The intensity of inflammatory reaction and types of complications in animals depended on the loop type and method of finishing of the mesh endoprosthesis tissue. __________ Translated from Byulleten’ Eksperimental’noi Biologii i Meditsiny, Vol. 145, No. 5, pp. 582–587, May, 2008     

疝环充填式无张力疝修补术治疗腹股沟疝

目的：总结应用疝环充填式无张力疝修补术治疗腹股沟疝的临床经验。方法：采用美国巴德公司的疝环充填物及网状补片,对28例腹股沟疝进行无张力疝修补术。结果：与传统疝修补术相比,疝环充填式无张力疝修补术具有创伤小,术后疼痛轻、恢复快等优点。全组28例病人随访2－14个月,未见复发。结论：疝环充填式无张力疝修补术具有操作简便,创伤小、恢复快、复发率低等优点,是一项更符合人体解剖结构的良好手术方法。