Context and Objective: Groin hernia is a common pathology in visceral surgery (2nd rank after appendicitis), which affects approximately 4.6% of the African population. Restoring the normal anatomy of the groin region...Context and Objective: Groin hernia is a common pathology in visceral surgery (2nd rank after appendicitis), which affects approximately 4.6% of the African population. Restoring the normal anatomy of the groin region is one of the most benign interventions. However, uro-andrological complications are possible. This study aimed to contribute to the improvement of the management of urogenital complications of groin hernia surgery. Patients and Method: We carried out a prospective study of descriptive type with a duration of 6 months from 1 August 2021 to 31 January 2022. The data were collected using a pre-established survey sheet. The study covered several sites (public hospitals and private clinics) in Guinea. Results: The urogenital complications of the surgery of the hernia of the groin represented 15.22% or 14 cases out of 92 patients. The average age was 37.00 years with extremes of 20-69 years. Polygamists occupied the first place. The reason for consultation was dominated by decreased testicular volume (42.86%), followed by a desire to conceive (21.43%). Unilateral testicular atrophy represented 63.64%, bilateral 27.27%. We performed a left orchidectomy in one patient and a cystorraphy in another simple operative follow-up. The other cases consisting of testicular atrophy, due to lack of a suitable technical platform, did not benefit from any specific therapeutic treatment. Conclusion: Urogenital complications of groin hernia surgery are relatively common. Testicular atrophy was the main clinical complication. The left orchidectomy and cystorraphy were the therapeutic procedures performed.展开更多
Groins are employed to prevent nearshore areas from erosion and to control the direction of flow. However, the groin structure and its associated flow characteristics are the main causes of local erosion. In this stud...Groins are employed to prevent nearshore areas from erosion and to control the direction of flow. However, the groin structure and its associated flow characteristics are the main causes of local erosion. In this study, we investigate the flow patterns around refractive and right-angle groins. In particular, we analytically compare the flow characteristics around a refractive groin and study the degree of accuracy that can be achieved by using a right-angle groin of various projected lengths. To compare the flow characteristics, we replaced the right-angle groin with an approximation of a refractive groin. This replacement had the least effect on the maximum velocity of flow in the channel. Moreover, we investigated the distribution of the density variables of temperature and salinity, and their effects on the flow characteristics around the right-angle groin. A comparison of the flow analysis results in baroclinic and barotropic conditions reveals that the flow characteristic values are very similar for both the refractive and right-angle groins. The geometry of the groin, i.e., right-angle or refractive, has little effect on the maximum speed to relative average speed. Apart from the angular separation, the arm length of the groin in downstream refractive groins has less effect on other flow characteristics than do upstream refractive groins. We also correlated a number of non-dimensional variables with respect to various flow characteristics and groin geometry. These comparisons indicate that the correlation between the thalweg height and width of the channel and groin arm＇s length to projection length have been approximated using linear and nonlinear formulas regardless of inner velocity in the subcritical flow.展开更多
Hernia is a common problem of the modern world with its incidence more in developing countries. Inguinal hernia is the most common groin hernia repaired worldwide. With advancement in technology operative techniques o...Hernia is a common problem of the modern world with its incidence more in developing countries. Inguinal hernia is the most common groin hernia repaired worldwide. With advancement in technology operative techniques of repair have also evolved. A Pub Med and COCHRANE database search was accomplished in this regard to establish the current status of laparoscopic inguinal hernia repair in view of recent published literature. Published literature support that laparoscopic hernia repair is best suited for recurrent and bilateral inguinal hernia although it may be offered for primary inguinal hernia if expertise is available.展开更多
Inguinodynia(chronic groin pain) is one of the recognised complications of the commonly performed Lichtenstein mesh inguinal hernia repair.This has major impact on quality of life in a significant proportion of patien...Inguinodynia(chronic groin pain) is one of the recognised complications of the commonly performed Lichtenstein mesh inguinal hernia repair.This has major impact on quality of life in a significant proportion of patients.The pain is classif ied as neuropathic and nonneuropathic related to nerve damage and to the mesh,respectively.Correct diagnosis of this problem is relatively difficult.A thorough history and clinical examination are essential,as is a good knowledge of the groin nerve distribution.In spite of the common nature of the problem,the literature evidence is limited.In this paper we discuss the diagnostic tools and treatment options,both non-surgical and surgical.In addition,we discuss the criteria for surgical intervention and its optimal timing.展开更多
The wind pressure distribution and wind-induced vibration responses of long-span spatial groined latticed vaults （SGLVs） were numerically simulated, which always are ones of the most important problems in the struct...The wind pressure distribution and wind-induced vibration responses of long-span spatial groined latticed vaults （SGLVs） were numerically simulated, which always are ones of the most important problems in the structural wind resistance design. Incompressible visco-fluid model was introduced, and the standard k - two equation model and semi-implicit method for pressure linked equation （SIMPLE） were used to describe the flow turbulence. Furthermore, the structural dynamic equation was set up, which is solved by Newmark-fl method. And several sort of wind-induced vibration coefficients such as the wind-induced vibration coefficient corresponding to the nodal displacement responses and wind loads were suggested. In the numerical simulation where the SGLV consisting of the cylindrical sectors with different curved surface was chosen as the example, the influence on the relative wind pressure distribution and structural wind-induced vibration responses of the closed or open SGLV caused by such parameters as the number of cylindrical sectors, structural curvature and the ratio of rise to span was investigated. Finally, some useful conclusions on the local wind pressure distribution on the structural surface and the wind-induced vibration coefficients of SGLV were developed.展开更多
Groin hernias include indirect inguinal,direct inguinal,femoral,obturator,and supravesical hernias.Here,we summarize historical turning points,anatomical recognition and surgical repairs.Groin hernias have a fascinati...Groin hernias include indirect inguinal,direct inguinal,femoral,obturator,and supravesical hernias.Here,we summarize historical turning points,anatomical recognition and surgical repairs.Groin hernias have a fascinating history in the fields of anatomy and surgery.The concept of tension-free repair is generally accepted among clinicians.Surgical repair with mesh is categorized as hernioplasty,while classic repair without mesh is considered herniorrhaphy.Although various surgical approaches have been developed,the surgical technique should be carefully chosen for each patient.Regarding as interesting history,crucial anatomy and important surgeries in the field of groin hernia,we here summarized them in detail,respectively.Points of debate are also reviewed;important points are shown using illustrations and schemas.We hope this systematic review is surgical guide for general surgeons including residents.Both a skillful technique and anatomical knowledge are indispensable for successful hernia surgery in the groin.展开更多
We report a case of right lower abdominal wall and groin abscess resulting from acute appendicitis. The patient was an 27-year-old man who had no apparent abdominal signs and was brought to the hospital due to progres...We report a case of right lower abdominal wall and groin abscess resulting from acute appendicitis. The patient was an 27-year-old man who had no apparent abdominal signs and was brought to the hospital due to progressive painful swelling of right lower abdomen and the groin for 10 d. Significant inflammatory changes of soft tissue involving the right lower trunk were noted without any apparent signs of peritonitis. Laboratory results revealed leukocytosis. Abdominal ultrasonography described the presence of abscess at right inguinal site also communicating with the intraabdominal region. Right inguinal exploration and laparotomy were performed and about 250 mL of pus was drained from the subcutaneous tissue and preperitoneal space. No collection of pus was found intraabdominally and subserous acute appendicitis was the cause of the abscess. The patient fully recovered at the end of the second post-operation week. This case reminds us that acute appendicitis may have an atypical clinical presentation and should be treated carefully on an emergency basis to avoid serious complications.展开更多
Bacterial infection due to coronary angiography is an uncommon but important complication of percutaneous coronary intervention (PCI) which is responsible for significant morbidity and extended hospital stay. The reas...Bacterial infection due to coronary angiography is an uncommon but important complication of percutaneous coronary intervention (PCI) which is responsible for significant morbidity and extended hospital stay. The reasons for this symptom are still unclear. We report a case of local groin abscess two weeks after the latest procedure. The reasons responsible for the groin abscess in this case might be diabetes mellitus without being properly controlled, left ventricular (LV) systolic dysfunction, multiple operations in the same site, the usage of vascular closure device (VCD), and long time pressure after the procedure. We should pay enough attention to these risk factors in the future clinical practice to avoid this serious complication.展开更多
Introduction: Single incision laparoscopic surgery (SILS) has become more popular for various surgical procedures including hernia surgery. Initial results of SILS in elective hernia repair were comparable to those of...Introduction: Single incision laparoscopic surgery (SILS) has become more popular for various surgical procedures including hernia surgery. Initial results of SILS in elective hernia repair were comparable to those of conventional laparoscopic approaches. However the use of SILS in emergency case has not been widely reported. This study aimed to evaluate the feasibility of the use of single incision laparoscopic transabdominal preperitoneal (TAPP) repair for patients presenting with strangulated groin hernia. Method: Emergency single incision laparoscopic TAPP repair were performed in our unit from June 2011 onwards for selected patients. Retrospectively data including the patient demographics, operative time, type of hernia, hospital stay, complications and recurrence rate were collected and analyzed. Result: There were a total of five patients in this series from June 2011 to June 2012. The median age was 62 years old with a male to female ratio of 4:1. Four patients had unilateral hernia (one femoral and three inguinal hernias) and one had bilateral hernia (unilaterally strangulated femoral hernia and bilaterally reducible indirect inguinal hernia). The median operative time was 75 minutes for patients with unilateral repair. None of the patients required bowel resection. The conversion rate to either conventional laparoscopic or open repair was zero. The median hospital stay was 2 days. No major complication or recurrence was detected. Conclusion: This series showed that single port laparoscopic TAPP repair for strangulated groin hernia is a feasible option with no major complication reported.展开更多
The purpose is to contribute new information to the existing body of knowledge of the physiology of the groin. In a prospective ultrasonographic study, after an informed consent, 10 men and 10 women who were intact in...The purpose is to contribute new information to the existing body of knowledge of the physiology of the groin. In a prospective ultrasonographic study, after an informed consent, 10 men and 10 women who were intact in the groin areas of surgery or relevant disease were involved. For a comparison, additional groups of 5 men and 5 women with abdominal wall hernias, but with no groin hernias, and other 5 men with inguinal hernias were included. The distal descent of the internal oblique muscle during the Valsalva’s manoeuvre in men was 0.8 cm ± 0.1 and in women it was 0.3 cm ± 0.1 (p < 0.001);the plate of transversus abdominis muscle changed its initial configurations and took on the characteristics of aponeurosis. During the Valsalva manoeuvre the rectus abdominis muscle demonstrated a distal latero-caudal shift of its lateral margin. In individuals with failed mechanics of the abdominal wall, the rectus abdominus does not realize the protective function. The mobile anatomic structures in the groin are oriented in three frontal planes. It formulated the concept of a synchronous protective function of all myofascial structures in the groin. We established that the anatomic structures transform the inguinal canal into a hermetic entity, which protects both the ingunal canal and the spermatic cord.展开更多
Inguinal hernia is a prevalent global surgical condition,accounting for millions of repairs annually.Tension-free mesh repair has become the gold standard for both open approaches(e.g.,Lichtenstein repair)and laparosc...Inguinal hernia is a prevalent global surgical condition,accounting for millions of repairs annually.Tension-free mesh repair has become the gold standard for both open approaches(e.g.,Lichtenstein repair)and laparoscopic techniques(e.g.,transabdominal preperitoneal and totally extraperitoneal[TEP]repairs).1,2,3 Guidelines updated in 2018 and 2023 emphasize mesh-based repairs,providing recommendations to optimize outcomes and minimize complications.1,2 Laparoscopic hernia repair,particularly TEP,offers several advantages,such as reduced pain,quicker recovery,and improved cosmetic outcomes.展开更多
目的:探讨外阴肌上皮瘤样肿瘤(myoepithelioma-like tumors of the vulvar region, MELTVR)的临床病理学特征、分子特征、诊断及鉴别诊断。方法:回顾性分析我院1例发生于左侧腹股沟MELTVR临床病理学资料,并进行相关文献复习。结果:患者...目的:探讨外阴肌上皮瘤样肿瘤(myoepithelioma-like tumors of the vulvar region, MELTVR)的临床病理学特征、分子特征、诊断及鉴别诊断。方法:回顾性分析我院1例发生于左侧腹股沟MELTVR临床病理学资料,并进行相关文献复习。结果:患者女,35岁,以“左侧腹股沟肿物2次手术后再发1个月”为主诉入院。镜检示:肿瘤呈弥漫实性分布,其内可见大小不等的滤泡样结构及片状坏死。肿瘤细胞呈上皮样或梭形,间质可见多量小血管增生,呈圆形或分枝状,部分区域可见肿瘤细胞围血管生长、呈“假菊形团”样结构。高倍镜下,胞质嗜酸、局灶胞质透亮,核染色质不均匀、略呈泡状,可见一到数个小核仁,核分裂象易见(>20/10 HPF)。肿瘤位于皮下脂肪组织,可见一层纤细的纤维组织与周围组织分隔,局灶可见脂肪组织浸润。免疫表型:ER、EMA和Vimentin弥漫阳性,INI1阴性。FISH结果显示:EWSR1基因无断裂。结论:MELTVR是一种罕见的发生于女性外阴区的间叶源性肿瘤。它具有多变的组织学模式。与以往文献不同的是该病例未见明确的黏液样区域,正确认识该疾病有助于避免误诊和漏诊。展开更多
Acute pancreatitis is an inflammatory process with .variable involvement of regional tissue, remote organ systems, or both. Various complications of pancreatitis are common, including intra- or extrapancreatic fluid c...Acute pancreatitis is an inflammatory process with .variable involvement of regional tissue, remote organ systems, or both. Various complications of pancreatitis are common, including intra- or extrapancreatic fluid collections and development of a pancreatic pseudocyst or abscess, or even pancreatic tissue necrosis. Infected necrosis involves diffuse bacterial inflammation of necrotic pancreatic and peripancreatic tissue without significant pus collection. In contrast, a pancreatic abscess is a circumscribed collection of pus, usually in proximity to the pancreas, that is positive for bacteria, bounded by adjacent tissue and organs and has minimal amounts of associated necrosis.展开更多
The omentum is a well-established pedicled flap for coverage of intra-abdominal and thoracic pathology, and as a free-flap for a multitude of applications. Its use as a pedicled flap for extra-abdominal applications o...The omentum is a well-established pedicled flap for coverage of intra-abdominal and thoracic pathology, and as a free-flap for a multitude of applications. Its use as a pedicled flap for extra-abdominal applications other than those on the chest is less well described. Here we present a case where a pedicled omental flap was utilized to provide circumferential and buried coverage of an in-line ilio-femoral bypass graft well below the level of the inguinal ligament. The reach of the omentum was more than adequate, and the delicate nature of the flap provided excellent circumferential coverage of a cryo-vein bypass graft.展开更多
BACKGROUND Women have a 3%lifetime chance of developing an inguinal hernia,which is not as common in men.Due to its cosmetic benefits,single-incision laparoscopic transabdominal preperitoneal(SIL-TAPP)inguinal hernia ...BACKGROUND Women have a 3%lifetime chance of developing an inguinal hernia,which is not as common in men.Due to its cosmetic benefits,single-incision laparoscopic transabdominal preperitoneal(SIL-TAPP)inguinal hernia repair is becoming in-creasingly popular in the management of inguinal hernia in women.However,there are no studies comparing the safety and applicability of SIL-TAPP repair with conventional laparoscopic transabdominal preperitoneal(CL-TAPP)inguinal hernia repair for the treatment of inguinal hernia in women.AIM To compare the outcomes of SIL-TAPP and CL-TAPP repair in adult female patients with inguinal hernia and to estimate the safety and applicability of SIL-TAPP repair in adult female inguinal hernia patients.METHODS We retrospectively compared the clinical information and follow-up data of fe-male inguinal hernia patients who underwent SIL-TAPP inguinal hernia repair and those who underwent CL-TAPP inguinal hernia repair at the Affiliated Hos-pital of Nantong University from February 2018 to December 2020 and assessed the long-term and short-term outcomes of both cohorts.RESULTS This study included 123 patients,with 71 undergoing SIL-TAPP repair and 52 un-dergoing CL-TAPP repair.The two cohorts of patients and inguinal hernia charac-teristics were similar,with no statistically meaningful difference.The rate of intraoperative inferior epigastric vessel injury was lower in patients in the SIL-TAPP cohort(0,0%)than in patients in the CL-TAPP cohort(4,7.7%)and was significantly different(P<0.05).In addition,the median[interquartile range(IQR)]total hospitalization costs were significantly lower in patients in the SIL-TAPP cohort[$3287(3218-3325)]than in patients in the CL-TAPP cohort[$3511(3491-3599)].Postoperatively,the occurrence rate of trocar site hernia was lower in the SIL-TAPP cohort(0,0%)than in the CL-TAPP cohort(4,7.7%),and the median(IQR)cosmetic score was significantly higher in the SIL-TAPP cohort[10(10-10)]than in the CL-TAPP cohort[9(9-10)].CONCLUSION SIL-TAPP repair did not increase the incidence of intraoperative and postoperative complications in female in-guinal hernia patients.Moreover,female inguinal hernia patients who underwent SIL-TAPP repair had a lower probability of trocar site hernia and inferior epigastric vessel injury than female inguinal hernia patients who un-derwent CL-TAPP repair.In addition,female inguinal hernia patients who underwent SIL-TAPP repair reported a more aesthetically pleasing postoperative abdominal incision.Therefore,SIL-TAPP repair is a better option for the treatment of inguinal hernias in women.展开更多
文摘Context and Objective: Groin hernia is a common pathology in visceral surgery (2nd rank after appendicitis), which affects approximately 4.6% of the African population. Restoring the normal anatomy of the groin region is one of the most benign interventions. However, uro-andrological complications are possible. This study aimed to contribute to the improvement of the management of urogenital complications of groin hernia surgery. Patients and Method: We carried out a prospective study of descriptive type with a duration of 6 months from 1 August 2021 to 31 January 2022. The data were collected using a pre-established survey sheet. The study covered several sites (public hospitals and private clinics) in Guinea. Results: The urogenital complications of the surgery of the hernia of the groin represented 15.22% or 14 cases out of 92 patients. The average age was 37.00 years with extremes of 20-69 years. Polygamists occupied the first place. The reason for consultation was dominated by decreased testicular volume (42.86%), followed by a desire to conceive (21.43%). Unilateral testicular atrophy represented 63.64%, bilateral 27.27%. We performed a left orchidectomy in one patient and a cystorraphy in another simple operative follow-up. The other cases consisting of testicular atrophy, due to lack of a suitable technical platform, did not benefit from any specific therapeutic treatment. Conclusion: Urogenital complications of groin hernia surgery are relatively common. Testicular atrophy was the main clinical complication. The left orchidectomy and cystorraphy were the therapeutic procedures performed.
文摘Groins are employed to prevent nearshore areas from erosion and to control the direction of flow. However, the groin structure and its associated flow characteristics are the main causes of local erosion. In this study, we investigate the flow patterns around refractive and right-angle groins. In particular, we analytically compare the flow characteristics around a refractive groin and study the degree of accuracy that can be achieved by using a right-angle groin of various projected lengths. To compare the flow characteristics, we replaced the right-angle groin with an approximation of a refractive groin. This replacement had the least effect on the maximum velocity of flow in the channel. Moreover, we investigated the distribution of the density variables of temperature and salinity, and their effects on the flow characteristics around the right-angle groin. A comparison of the flow analysis results in baroclinic and barotropic conditions reveals that the flow characteristic values are very similar for both the refractive and right-angle groins. The geometry of the groin, i.e., right-angle or refractive, has little effect on the maximum speed to relative average speed. Apart from the angular separation, the arm length of the groin in downstream refractive groins has less effect on other flow characteristics than do upstream refractive groins. We also correlated a number of non-dimensional variables with respect to various flow characteristics and groin geometry. These comparisons indicate that the correlation between the thalweg height and width of the channel and groin arm＇s length to projection length have been approximated using linear and nonlinear formulas regardless of inner velocity in the subcritical flow.
文摘Hernia is a common problem of the modern world with its incidence more in developing countries. Inguinal hernia is the most common groin hernia repaired worldwide. With advancement in technology operative techniques of repair have also evolved. A Pub Med and COCHRANE database search was accomplished in this regard to establish the current status of laparoscopic inguinal hernia repair in view of recent published literature. Published literature support that laparoscopic hernia repair is best suited for recurrent and bilateral inguinal hernia although it may be offered for primary inguinal hernia if expertise is available.
文摘Inguinodynia(chronic groin pain) is one of the recognised complications of the commonly performed Lichtenstein mesh inguinal hernia repair.This has major impact on quality of life in a significant proportion of patients.The pain is classif ied as neuropathic and nonneuropathic related to nerve damage and to the mesh,respectively.Correct diagnosis of this problem is relatively difficult.A thorough history and clinical examination are essential,as is a good knowledge of the groin nerve distribution.In spite of the common nature of the problem,the literature evidence is limited.In this paper we discuss the diagnostic tools and treatment options,both non-surgical and surgical.In addition,we discuss the criteria for surgical intervention and its optimal timing.
基金the Key Project of Fund of Science and Technology Development of Shanghai (No. 07JC14023)the National Natural Science Foundation of China(No. 10572091)
文摘The wind pressure distribution and wind-induced vibration responses of long-span spatial groined latticed vaults （SGLVs） were numerically simulated, which always are ones of the most important problems in the structural wind resistance design. Incompressible visco-fluid model was introduced, and the standard k - two equation model and semi-implicit method for pressure linked equation （SIMPLE） were used to describe the flow turbulence. Furthermore, the structural dynamic equation was set up, which is solved by Newmark-fl method. And several sort of wind-induced vibration coefficients such as the wind-induced vibration coefficient corresponding to the nodal displacement responses and wind loads were suggested. In the numerical simulation where the SGLV consisting of the cylindrical sectors with different curved surface was chosen as the example, the influence on the relative wind pressure distribution and structural wind-induced vibration responses of the closed or open SGLV caused by such parameters as the number of cylindrical sectors, structural curvature and the ratio of rise to span was investigated. Finally, some useful conclusions on the local wind pressure distribution on the structural surface and the wind-induced vibration coefficients of SGLV were developed.
文摘Groin hernias include indirect inguinal,direct inguinal,femoral,obturator,and supravesical hernias.Here,we summarize historical turning points,anatomical recognition and surgical repairs.Groin hernias have a fascinating history in the fields of anatomy and surgery.The concept of tension-free repair is generally accepted among clinicians.Surgical repair with mesh is categorized as hernioplasty,while classic repair without mesh is considered herniorrhaphy.Although various surgical approaches have been developed,the surgical technique should be carefully chosen for each patient.Regarding as interesting history,crucial anatomy and important surgeries in the field of groin hernia,we here summarized them in detail,respectively.Points of debate are also reviewed;important points are shown using illustrations and schemas.We hope this systematic review is surgical guide for general surgeons including residents.Both a skillful technique and anatomical knowledge are indispensable for successful hernia surgery in the groin.
文摘We report a case of right lower abdominal wall and groin abscess resulting from acute appendicitis. The patient was an 27-year-old man who had no apparent abdominal signs and was brought to the hospital due to progressive painful swelling of right lower abdomen and the groin for 10 d. Significant inflammatory changes of soft tissue involving the right lower trunk were noted without any apparent signs of peritonitis. Laboratory results revealed leukocytosis. Abdominal ultrasonography described the presence of abscess at right inguinal site also communicating with the intraabdominal region. Right inguinal exploration and laparotomy were performed and about 250 mL of pus was drained from the subcutaneous tissue and preperitoneal space. No collection of pus was found intraabdominally and subserous acute appendicitis was the cause of the abscess. The patient fully recovered at the end of the second post-operation week. This case reminds us that acute appendicitis may have an atypical clinical presentation and should be treated carefully on an emergency basis to avoid serious complications.
文摘Bacterial infection due to coronary angiography is an uncommon but important complication of percutaneous coronary intervention (PCI) which is responsible for significant morbidity and extended hospital stay. The reasons for this symptom are still unclear. We report a case of local groin abscess two weeks after the latest procedure. The reasons responsible for the groin abscess in this case might be diabetes mellitus without being properly controlled, left ventricular (LV) systolic dysfunction, multiple operations in the same site, the usage of vascular closure device (VCD), and long time pressure after the procedure. We should pay enough attention to these risk factors in the future clinical practice to avoid this serious complication.
文摘Introduction: Single incision laparoscopic surgery (SILS) has become more popular for various surgical procedures including hernia surgery. Initial results of SILS in elective hernia repair were comparable to those of conventional laparoscopic approaches. However the use of SILS in emergency case has not been widely reported. This study aimed to evaluate the feasibility of the use of single incision laparoscopic transabdominal preperitoneal (TAPP) repair for patients presenting with strangulated groin hernia. Method: Emergency single incision laparoscopic TAPP repair were performed in our unit from June 2011 onwards for selected patients. Retrospectively data including the patient demographics, operative time, type of hernia, hospital stay, complications and recurrence rate were collected and analyzed. Result: There were a total of five patients in this series from June 2011 to June 2012. The median age was 62 years old with a male to female ratio of 4:1. Four patients had unilateral hernia (one femoral and three inguinal hernias) and one had bilateral hernia (unilaterally strangulated femoral hernia and bilaterally reducible indirect inguinal hernia). The median operative time was 75 minutes for patients with unilateral repair. None of the patients required bowel resection. The conversion rate to either conventional laparoscopic or open repair was zero. The median hospital stay was 2 days. No major complication or recurrence was detected. Conclusion: This series showed that single port laparoscopic TAPP repair for strangulated groin hernia is a feasible option with no major complication reported.
文摘The purpose is to contribute new information to the existing body of knowledge of the physiology of the groin. In a prospective ultrasonographic study, after an informed consent, 10 men and 10 women who were intact in the groin areas of surgery or relevant disease were involved. For a comparison, additional groups of 5 men and 5 women with abdominal wall hernias, but with no groin hernias, and other 5 men with inguinal hernias were included. The distal descent of the internal oblique muscle during the Valsalva’s manoeuvre in men was 0.8 cm ± 0.1 and in women it was 0.3 cm ± 0.1 (p < 0.001);the plate of transversus abdominis muscle changed its initial configurations and took on the characteristics of aponeurosis. During the Valsalva manoeuvre the rectus abdominis muscle demonstrated a distal latero-caudal shift of its lateral margin. In individuals with failed mechanics of the abdominal wall, the rectus abdominus does not realize the protective function. The mobile anatomic structures in the groin are oriented in three frontal planes. It formulated the concept of a synchronous protective function of all myofascial structures in the groin. We established that the anatomic structures transform the inguinal canal into a hermetic entity, which protects both the ingunal canal and the spermatic cord.
文摘Inguinal hernia is a prevalent global surgical condition,accounting for millions of repairs annually.Tension-free mesh repair has become the gold standard for both open approaches(e.g.,Lichtenstein repair)and laparoscopic techniques(e.g.,transabdominal preperitoneal and totally extraperitoneal[TEP]repairs).1,2,3 Guidelines updated in 2018 and 2023 emphasize mesh-based repairs,providing recommendations to optimize outcomes and minimize complications.1,2 Laparoscopic hernia repair,particularly TEP,offers several advantages,such as reduced pain,quicker recovery,and improved cosmetic outcomes.
文摘目的:探讨外阴肌上皮瘤样肿瘤(myoepithelioma-like tumors of the vulvar region, MELTVR)的临床病理学特征、分子特征、诊断及鉴别诊断。方法:回顾性分析我院1例发生于左侧腹股沟MELTVR临床病理学资料,并进行相关文献复习。结果:患者女,35岁,以“左侧腹股沟肿物2次手术后再发1个月”为主诉入院。镜检示:肿瘤呈弥漫实性分布,其内可见大小不等的滤泡样结构及片状坏死。肿瘤细胞呈上皮样或梭形,间质可见多量小血管增生,呈圆形或分枝状,部分区域可见肿瘤细胞围血管生长、呈“假菊形团”样结构。高倍镜下,胞质嗜酸、局灶胞质透亮,核染色质不均匀、略呈泡状,可见一到数个小核仁,核分裂象易见(>20/10 HPF)。肿瘤位于皮下脂肪组织,可见一层纤细的纤维组织与周围组织分隔,局灶可见脂肪组织浸润。免疫表型:ER、EMA和Vimentin弥漫阳性,INI1阴性。FISH结果显示:EWSR1基因无断裂。结论:MELTVR是一种罕见的发生于女性外阴区的间叶源性肿瘤。它具有多变的组织学模式。与以往文献不同的是该病例未见明确的黏液样区域,正确认识该疾病有助于避免误诊和漏诊。
文摘Acute pancreatitis is an inflammatory process with .variable involvement of regional tissue, remote organ systems, or both. Various complications of pancreatitis are common, including intra- or extrapancreatic fluid collections and development of a pancreatic pseudocyst or abscess, or even pancreatic tissue necrosis. Infected necrosis involves diffuse bacterial inflammation of necrotic pancreatic and peripancreatic tissue without significant pus collection. In contrast, a pancreatic abscess is a circumscribed collection of pus, usually in proximity to the pancreas, that is positive for bacteria, bounded by adjacent tissue and organs and has minimal amounts of associated necrosis.
文摘The omentum is a well-established pedicled flap for coverage of intra-abdominal and thoracic pathology, and as a free-flap for a multitude of applications. Its use as a pedicled flap for extra-abdominal applications other than those on the chest is less well described. Here we present a case where a pedicled omental flap was utilized to provide circumferential and buried coverage of an in-line ilio-femoral bypass graft well below the level of the inguinal ligament. The reach of the omentum was more than adequate, and the delicate nature of the flap provided excellent circumferential coverage of a cryo-vein bypass graft.
基金Supported by Wu Jieping Medical Foundation,No.320.6750.18396Nantong“14th Five-Year”Science and Education to Strengthen Health Project,General Surgery Medical Key Discipline,No.42and Nantong Municipal Commission of Health and Family Planning,No.MS2022005.
文摘BACKGROUND Women have a 3%lifetime chance of developing an inguinal hernia,which is not as common in men.Due to its cosmetic benefits,single-incision laparoscopic transabdominal preperitoneal(SIL-TAPP)inguinal hernia repair is becoming in-creasingly popular in the management of inguinal hernia in women.However,there are no studies comparing the safety and applicability of SIL-TAPP repair with conventional laparoscopic transabdominal preperitoneal(CL-TAPP)inguinal hernia repair for the treatment of inguinal hernia in women.AIM To compare the outcomes of SIL-TAPP and CL-TAPP repair in adult female patients with inguinal hernia and to estimate the safety and applicability of SIL-TAPP repair in adult female inguinal hernia patients.METHODS We retrospectively compared the clinical information and follow-up data of fe-male inguinal hernia patients who underwent SIL-TAPP inguinal hernia repair and those who underwent CL-TAPP inguinal hernia repair at the Affiliated Hos-pital of Nantong University from February 2018 to December 2020 and assessed the long-term and short-term outcomes of both cohorts.RESULTS This study included 123 patients,with 71 undergoing SIL-TAPP repair and 52 un-dergoing CL-TAPP repair.The two cohorts of patients and inguinal hernia charac-teristics were similar,with no statistically meaningful difference.The rate of intraoperative inferior epigastric vessel injury was lower in patients in the SIL-TAPP cohort(0,0%)than in patients in the CL-TAPP cohort(4,7.7%)and was significantly different(P<0.05).In addition,the median[interquartile range(IQR)]total hospitalization costs were significantly lower in patients in the SIL-TAPP cohort[$3287(3218-3325)]than in patients in the CL-TAPP cohort[$3511(3491-3599)].Postoperatively,the occurrence rate of trocar site hernia was lower in the SIL-TAPP cohort(0,0%)than in the CL-TAPP cohort(4,7.7%),and the median(IQR)cosmetic score was significantly higher in the SIL-TAPP cohort[10(10-10)]than in the CL-TAPP cohort[9(9-10)].CONCLUSION SIL-TAPP repair did not increase the incidence of intraoperative and postoperative complications in female in-guinal hernia patients.Moreover,female inguinal hernia patients who underwent SIL-TAPP repair had a lower probability of trocar site hernia and inferior epigastric vessel injury than female inguinal hernia patients who un-derwent CL-TAPP repair.In addition,female inguinal hernia patients who underwent SIL-TAPP repair reported a more aesthetically pleasing postoperative abdominal incision.Therefore,SIL-TAPP repair is a better option for the treatment of inguinal hernias in women.
