Objective To investigate the therapeutic effects of the groin skin and iliac bone composite graft on the repair of severe contracture of the first web space and one-stage reconstruction of the pollicis opponens function under the condition of no ideal muscle or tendon used. Methods From July 2003 to February 2006, 5 patients (4 males, 1 females; age range, 2038 years) with severe contracture of the first web space with loss of the pollicis opponens function were treated by the groin skin and iliac bone composite graft, with the clinical observation performed. The defect was caused by a crush injury in 3 patients, by an explosion injury in 1 patient, and by awrist joint mutilation injury in 1 patient. They all had been treated by operation at least once with a disease course of 6-24 months. The width and the angle of the first web space was 18 mm and 20° on average. Results The followed-up for 612 moths revealed that all the flaps had a success. The pedicle of the groin skin and iliac bone composite graft was cut off after 3 weeks, and 8 weeks later there was a bone union between the imbedded bone block and the first and second metacarpal bones. There was no evidence that the imbedded bone block was deformed or absorbed. The width of the first web space was augmented by an average of 32 mm, the angle of the first web space was augmented by an average of 60°. The pollicis opponens function recovered. Conclusion It is relatively simple and reliable to repair the contracture of the first web space and reconstruct the pollicis opponens function in one-stage usingthe groin skin and iliac bone composite graft.
ObjectiveTo systematically evaluate the effect of single-port totally extraperitoneal (SPTEP) and conventional totally extraperitoneal (CTEP) inguinal hernia repair in treatment of inguinal hernia. MethodsPubMed, Cochrane Library, Embase, WanFang Data, VIP, and CNKI databases were electronically searched and the randomized controlled trial (RCT) and non-RCT studies on the efficacy and safety of SPTEP versus CTEP for patients with inguinal hernia from January 2010 to November 2019 were collected. Two reviewers independently screened literatures, extracted data, and assessed risk of bias of included studies, then the meta-analysis was performed by using RevMan5.3 software. ResultsA total of 17 clinical studies were included in the analysis, with 1 106 cases in the SPTEP group and 966 cases in the CTEP group. The results of meta-analysis showed that: the hospital stay [SMD=–0.12, 95%CI (–0.22, –0.02), P=0.01] and the time to resume normal activity [SMD=–1.17, 95%CI (–2.10, –0.23), P=0.01] were shorter, the satisfaction score of incision scars [SMD=0.92, 95%CI (0.31, 1.53), P<0.01] was higher in the SPTEP group as compared with the CTEP group. However, the operative time of SPTEP group was longer than that of the CTEP group both for unilateral inguinal hernia [MD=4.08, 95%CI (0.34, 7.83), P=0.03] and bilateral inguinal hernia [MD=5.53, 95%CI (0.39, 10.68), P=0.04]. There were no statistical differences in the postoperative pain score (24 h and 7 d), incidence of postoperative complications, the rate of patients satisfied with the incision, and hospitalization costs between the two groups (P>0.05). ConclusionsFrom the results of this meta-analysis, SPTEP has some certain advantages in shortening hospital stay and returning to normal activity time, and improving incision satisfaction. However, compared with CTEP, mean operative time of SPTEP is longer. Although SPTEP has developed for several years, it is difficult to replace CTEP.
ObjectiveTo investigate the surgical skills and clinical effects of the laparoscopic transabdominal preperitoneal (TAPP) inguinal hernia repair in treatment of recurrent inguinal hernia with plug prefix mesh. MethodsThe clinical data such as operation time, intraoperative blood loss, postoperative hospital stay, and postoperative complications of 87 patients with recurrent inguinal hernia reoperated in laparoscopic TAPP after inguinal hernioplasty with plug prefix mesh (recurrent hernia group), in the Department of Gastroenterology and Hernia surgery of the First Affiliated Hospital of Kunming Medical University from January 2011 to December 2013, were retrospectively analyzed, which were compared with the 834 incipient inguinal hernia patients operated first by TAPP (incipient hernia group) at the same time. ResultsThe operations were completed successfully in all of the 921 patients without conversion to open surgery. The operation time and intraoperative blood loss in the recurrent hernia group were significantly more than those in the incipient hernia group (P=0.000, P=0.000), the postoperative hospital stay had no signifcant difference between two groups (P=0.057). No recurrences were observed in the recurrent hernia group and incipient hernia group for following-up of (31±4) months and (28±6) months, respectively. Compared with the incipient hernia group, the rates of postoperative pain on day 30 and seroma on day 1 and 3 were higher in the recurrent hernia group (P=0.001, P=0.040, P=0.003, respectively). There were no severe complications such as collateral damage, foreign body sensation, incision infection, intestinal obstruction and so on in the two groups. ConclusionsThe laparoscopic TAPP inguinal hernia repair is safe and effective for patients with recurrent inguinal hernia with plug prefix mesh. More skills are required to reduce the complications. The operation time and intraoperative blood loss in reoperated patients with recurrent inguinal hernia are more than those in patients with incipient inguinal hernia. The rates of seroma on day 1 and 3 are also higher.
Objective To investigate an operative method of repairing large skin defect of the forearm and the hand. Methods From July 2003 to September 2008, 11 patients with large skin defect of the forearm and the hand were repaired using bilateral groin flaps in complex with abdominal flaps, including 7 males and 4 females aged 17-55 years old (average33.5 years old). Among the 11 cases, 5 were caused by carding machine and 4 by traffic accident, and the interval between injury and operation was 90 minutes to 6 hours (average 3.5 hours); 2 cases suffered from severe cicatricial contracture deformity in the late stage of burn injury, and the interval between injury and operation was 7 months and 19 months, respectively. The size of skin defect ranged from 42 cm × 12 cm to 60 cm × 16 cm. The flaps harvested during operation was 45.0 cm × 10.5 cm - 62.0 cm × 18.0 cm in size. Pedicle division of the combined flaps was performed 4 weeks after operation. The donor site wound was repaired by direct suturing in 7 cases and by free skin grafting in 4 cases. Results All flaps survived. All incisions healed by first intention. The donor site wound all healed by first intention. Skin graft all survived. All patients were followed up for 2 months to 3 years. The flaps were soft in texture, full in contour, and normal in color. Sensory recovery of the flaps was evaluated according to the Criteria of UK Medical Research Council (1954), 4 cases were in grade S1, 6 in grade S2, and 1 in grade S3. Hand function was assessed by the Criteria of Chinese Hand Surgery Society, 7 cases were graded as excellent, 2 as good, 2 as poor, and the excellent and good rate was 81.8%. Conclusion Combined use of bilateral groin flaps and abdominal flap is an effective approach to repair large skin defect of the forearm and the hand due to its simple operative procedure and satisfying effect.
Objective To explore the method and effectiveness of laparoscopic bundled fastigiated mesh in repairing inguinal hernia. Methods Between January 2003 and December 2009, 1 215 patients (1 363 sides) with inguinal hernia were treated. There were 1 132 males (1 268 sides) and 83 females (95 sides), aged from 18 to 89 years (median, 58 years). The cases included 1 187 cases (1 329 sides) of primary hernia and 28 cases (34 sides) of recurrent hernia. There were indirect inguinal hernia in 728 cases (786 sides), direct inguinal hernia in 416 cases (499 sides), femoral hernia in 43 cases (45 sides), and unusual hernia in 28 cases (33 sides). According to the hernia classification criteria, there were 31 cases (38 sides) in type I, 683 cases (754 sides) of type II, 403 cases (452 sides) of type III, and 98 cases (119 sides) of type IV. The disease duration was 1 to 9 days with an average of 3.8 days. To repair the hernia, the bundled fastigiated mesh was patched through the internal inguinal ring and fixed on the internal inguinal fascia by three-point fixation. The mesh would be wrapped in the peritoneum by purse-string suture. Results The surgeries were performd successfully. The operative time ranged from 18-32 minutes (mean, 22 minutes). Postoperative tractional pain in the inguinal region occurred in 19 cases (21 sides), acute uroschesis in 8 cases, and far-end hernial sac effusion in 2 cases (2 sides); all were cured after symptomatic treatment. All incisions healed by first intention, and no complications of fever, infection, or hematoma occurred. A total of 1 095 cases (1 182 sides) were followed up 1 to 7 years (median, 3 years and 9 months). Five patients died of medical illnesses at 1-3 years after operation. Three cases recurred and then were cured by a second surgery. No intestinal adhesion or obstruction occurred. Conclusion The bundled fastigiated mesh in laparoscopic inguinal hernia repair has the advantages of minimal invasiveness, easy-to-operate, less complications, and lower recurrence rate.
Objective To investigate the value of laparoscopy in resetting and repairing of inguinal incarcerated hernia. Methods Clinical data of 11 patients with acute inguinal incarcerated hernia treated with laparoscopy from March 2007 to February 2008 were reviewed, including 3 cases of direct inguinal hernia and 8 cases of oblique inguinal hernia. Results There were 7 patients with incarcerated hernia who were reset automatically after general anaesthesia, and 4 patients who were reset with laparoscopy. All the hernias were repaired with the transabdominal preperitoneal (TAPP) method after observed or improved the blood cycle of the incarcerated intestinal tract under laparoscopy. Average follow-up time was 6.6 months (2-12 months) after operation. Good recover and no recurrence were showed in all patients. Conclusion Laparoscopy is a safe technology in resetting and repairing of inguinal incarcerated hernia
目的评价应用疝环充填式无张力疝修补术治疗腹股沟嵌顿疝并发小肠坏死的手术效果。方法对于我院2001年5月至2009年5月期间收治的21例腹股沟嵌顿疝并发小肠坏死患者应用疝环充填式无张力疝修补术给予一期修补，先行坏死肠管切除，后置入网塞。结果无手术死亡病例，1例患者发生切口感染，经换药后治愈。平均住院时间65 d。全部患者随访6个月至8年，平均51个月，未见复发。结论 疝环充填式无张力疝修补具有创伤小、安全及患者恢复快的优点，对于腹股沟嵌顿疝并发小肠坏死可以行一期修补，临床效果满意。
目的 了解局部麻醉下腹股沟疝无张力修补术后患者排便变化的相关影响因素。 方法 采用自行设计的问卷调查表，对2010年5月－6月行无张力修补术的腹股沟疝患者术后排便情况及变化进行调查，并就相关影响因素采用logistic回归方法进行统计分析。 结果 腹股沟疝无张力修补术后患者进食量减少、活动量减少、饮食成分变化、担心排便引起复发是术后排便变化的影响因素。 结论 加强该病症术后健康宣传，指导患者正常进食、多活动，消除患者对腹股沟疝复发的焦虑，可促进其早期排便。Objective To research on the risk factors for change of defecation after inguinal hernia mesh-repairs under local anesthesia. Methods Self-made questionnaires were used to investigate the defecation change among patients having undergone inguinal hernia mesh-repairs from May to June 2010, and the correlated factors for change of defecation were analyzed by logistic regression analysis. Results Reduction of activity and food, changes of food ingredients, and worries about recurrence were risk factors for change of defecation. Conclusion In order to facilitate the recovery of the patients, nurses should promote patients’ knowledge on the surgery, guide them to eat as usual and do more exercises, and eliminate their anxiety on recurrence of the disease.
目的 总结腹股沟疝无张力疝修补术的手术经验。方法 回顾性分析我院2002年2月至2009年1月期间126例腹股沟疝患者行无张力疝修补术的临床资料及手术方法。结果 本组126例患者无围手术期死亡者,并发症主要有局部肿胀、异物感、疼痛等,随访6个月～6年(平均38个月)有6例(4.8%)复发。结论 无张力疝修补术是治疗腹股沟疝较为理想的术式。